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Skip the typing — snap a photo of your driver's license
We'll fill in your name, address, date of birth and license number wherever this form asks for them. You can still edit anything.
Drag & drop or click to upload a photo of your driver's license
How this works
Part 1 gets your general liability policy issued right away so the Norwalk lease is satisfied. Part 2 collects everything for the full program (workers comp, auto, property, umbrella) so we can turn it on the moment you're ready to open in October. We prefilled what we covered on the phone; fix anything that's off.
Part 1: Get the general liability policy issued now
Your contact info
The LLC
The policy goes in the LLC's name with Mr. Electric of Fairfield County as the DBA, since the lease and the franchise both run through the same entity.
Mailing address for the policy (if different from the office)
Start typing and pick your address from the list — city, state and ZIP fill in for you.
Owners / members, ownership %, and whether each one will be hands-on in the business *
The Norwalk office / flex space
This is what the landlord needs a certificate for.
Office address *
Start typing and pick your address from the list — city, state and ZIP fill in for you.
How will the space be used? *
Landlord / property owner legal name and address (exactly as it should appear on the certificate) *
Liability limits the lease requires *
Upload the lease (PDF)
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Drop in anything that helps
Drag & drop multiple files or click to browse. CASEY reads supported documents and keeps every original for review.
Operations for the general liability policy
We rate this as an electrical contractor at $0 revenue for now and raise it when you open. Carriers still ask these questions up front.
Where are you today? *
Expected work mix once open *
Electrical license status *
Will you use subcontractors? *
Any prior business insurance or claims for this LLC? *
Part 2: The full program for opening day
Mr. Electric franchise requirements
Insurance requirements from the franchise agreement (Item 8 of the FDD or the insurance exhibit). Paste them if you have them.
Upload the franchise agreement insurance section or requirements sheet
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Drop in anything that helps
Drag & drop multiple files or click to browse. CASEY reads supported documents and keeps every original for review.
Are you also getting a quote through the Gallagher franchise program?
Workers compensation
Required in Connecticut as soon as you have your first employee.
Should owners be covered under workers comp?
Commercial auto
Even before the vans arrive, hired and non-owned auto covers employees driving their own cars for the business.
Service vehicles planned for opening *
Vehicle details if you have them (year, make, model, VIN, owned or leased, lienholder, who drives)
Drivers: full name, date of birth, license number and state, years licensed
Property, tools, and equipment
Umbrella limit, if the lease or franchise requires one
Does Mr. Electric or the town require a contractor license bond?
Anything else we should know?
Your information is secure and will only be used to provide an insurance quote.