Artisan Contractor Quote

Please take a few minutes to complete the following information if you would like to obtain a quote.  Please understand, this is not an application.  If coverage is desired, an application will be sent to you.

All information provided is confidential and will be used solely for the purpose of providing a quote for you.

Name
Business Name
Business Entity
Street Address
City and Zip
Phone Number
Alternate Telephone
Fax Number
Email Address
Underwriting Information
Number of owners or officers
Number of Employees
Payroll of Owners/Officers
Payroll of Employees
Total annual gross receipts
Do you use subs?
Total annual sub costs
Do you require your subs to provide you insurance certificates equal to your liability limits
Describe all work performed
License Number, if any
License Type, if any
Years of experience
Years operated under current name
Other business names
Do you construct footings or foundations which may support dwellings or other structures?
Do you construct slab or monolithic floors?
Do you construct piers or underpinning which may support dwellings or other structures?
Do you construct retaining walls which may support dwellings or other structures?
What is the percentage of work done as a General Contractor?
What is the percentage of work done as a Sub-Contractor?
What is the percentage of work done on Residential?
What is the percentage of work done on Commercial?
What is the percentage of work done for Remodeling?
What is the percentage of work done for New Construction
What is the percentage of work done for Repair or Maintenance?
Claims Information
Were there any losses or claims in the last 5 years?
If yes, what is the date, amount paid and description of each loss or claim?
Current Insurance Company
How much are you paying now?
What is the liability limit requested?
Questions or Comments
Best Time To Contact You
Please let us know the best time to call and discuss your quote.
Or Specify Other:

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