Kimberly Stamm
Broker / President
kstamm@dkrenterprises.com

7668 El Camino Real, Suite 104
Carlsbad, CA 92009

Phone: 800.331.3001
Fax: 877.260.7474

CA Lic# 0E34870
AZ Lic# 197233
OR Lic#685057
WA Lic# 757907

DKR & Associates is licensed to do business in the states of California, Arizona, Oregon and Washington.

Professional & General Business Liability Insurance Quote

All information is required.
First and Last Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
E-mail:  
Business Name:  
Years in Business:  
Business Type:  

Insurance Company Name:  
Policy Exp. Date:  
Any Claims in Last 3 years?   
(if Yes, please describe)

Contractor's License Type:  
Est. Annual Gross Receipts:  
Est. Annual Employee Payroll:  
Est. Annual Sub-Out:  
Full-Time Employees:  
Part-Time Employees:  
Liability Limit:  
List any other coverages needed:  
Describe the type of work you do (business, product, services):  
Note: By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.