Contractor Quote Request

Contractors Insurance is quite complex. We give you the choice of continuing with this form or choose our Quick Form for your convenience. If you choose our Quick Form we will contact you for all the required information.

Contractors can present some unique insurance requirements. We have the knowledge and experience to help you get the proper coverage at the best premiums posssible.

COMPANY INFORMATION

Note- Coverage can not be bound or altered by this submission
Company name
Contact name
Address

City
State
Zip
Daytime telephone number
Alternate telephone number
Email address *
Legal Entity
Number Of Employees
Describe the Nature Of Your Business

REAL ESTATE OWNED

Does your company own any Real Estate?	if yes, Continue
Is its location the same as your Company address?	if No, complete below
Street Location of the Property
City & State
Zip

Type of Construction
Sprinklered
Security System
Describe the Type of Building
Describe All Occupancies

PERSONAL PROPERTY OWNED

Personal Property is property that is kept at a fixed location such as your office or warehouse.

Do you own any personal property?	if yes, Continue
Its location the same as Company address?	if No, complete below
Street Location of the Property
City & State
Zip

Sprinklered
Security System
Describe the Type of Building
Describe All Occupancies

TOOLS AND EQUIPMENT

Tools and equipment, quite often, are not at your office or warehouse. More often they are on your trucks or job sites. This property requires special consideration. Tools are generally described as items whose individual value is relatively low, but whose total value can be quite large. These are generally insured by their total value. Equipment is generally defined are those items whose individual value is more substancial. Thses items are insured individually each with its own description and value

Total Value of Tools
Briefly describe the equipment and values

PAYROLL AND CLASSIFICATIONS

The premium for Contractors General Liability Insurance is generally based upon payroll.
The rules permit many (Not All) contractors to divide their payroll into more than one classification. The
most common splits from your main classification are clerical and drivers. We list them below for your convenience.
If you have drivers and/or clerical employees, just enter their annual payroll then continue to your main classification/s or job descriptions. Briefly describe what the group does and enter the groups total annual payroll.

	Job Description (Classification)		Annual Payroll
	Drivers
	Clerical

DESIRED COVERAGES

Building Amount
Contents Amount
Loss of Income
Deductible
Limit of Liability
Describe Other Coverages Desired
Desired Effective Date

CURRENT POLICY INFORMATION

Renewal Date
Insurance Company
Current Premium
Describe any Losses in the Past 5 Years

COMMENTS

2048 Bit SSL Certificate