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Contractors Insurance Quote

  1. Contractors Insurance Quote
  • E&S Bonded and P&C Licensed
  • A Rated Insurers and Specialty Markets
Contractors Insurance QuoteBret Fair, RWCS, CAWC2024-04-30T10:47:07-07:00

"*" indicates required fields

Step 1 of 8

12%
Business Owner's Name*
Business Address*
Do you have other business operations active or inactive?*
Have you had any other business names & licenses in the past 10 years?*
Do you currently own/operate any other business?*

Current Operation Percentages

Please enter 0 below if an operation does not apply.
Do you use Subcontractors?*
(including all of subs' labor and materials)
Do you collect certificates from all subcontractors?*

Payroll Estimates

Estimated payroll for the next 12 months. All fields are required. Please enter 0 if no payroll.

5 Years Prior History

Construction Performed By You

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Estimated Types of Construction Work to Perform

Please enter the estimated percentage of construction work to be performed over the next 12 months using payroll Direct and Subcontracted.
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Projects

Please enter a number greater than or equal to 0.
Have you ever built a home from the ground up?*
Have you built, or will you build, on hillsides, terraces, landfills, or Subsidence areas?*
Do you use scaffolding?*
Have you been involved, or will you be involved, with blasting operations or any other hazardous work activity?*
Do you perform synthetic stucco work (EIFS)?*
Do any of your subcontractors perform EIFS work?*
Have you, or will you, build/demolish buildings or structures in excess of 4 stories?*
Do you perform work above 2 stories in height (other than interior remodel)?*
Do you perform work at airports?*
Do you own, rent, or subcontract any cranes?*
Have you been involved or will you or your subcontractors be involved in any removal of asbestos, PCB's or other hazardous materials?*
Removal or work on fuel tanks or pipelines?*
Do you or your subcontractors perform roofing work?*
Hot Tar?*
Torch Down?*
Hot Air Welding*
Modified Bituman (HOT)*
Modified Bituman (COLD)*
Do you perform any Mold Remediation work?*
Do any of your subcontractors perform Mold Remediation work?*
Have you performed, or will you or your subcontractors, perform any work below grade?*
Please enter a number from 0 to 100.
Any shoring, underpinning, cofferda, or caisson work?*
Have you worked or will you or your employees work under U.S. Longshoremen's and harbor Workers Act or Jones Maritime Act?*
Do you have a formal safety program in place?*
Will any work involve the construction of or involvement with Condominiums or Townhouses?*
Is condo work on New Construction or Repair or Remodel only?*
Will any work involve the construction of or involvement with Apartments?*
Is apartment work on New Construction or Repair or Remodel only?*
Please enter a number greater than or equal to 0.
Will any work involve the construction of or involvement with new Duplexes, Triplexes, Fourplexes, or Patio Homes?*
Have you ever worked in new Condominiums/Townhouses?*
Have you ever worked in new Apartments?*
Have you ever worked in new Duplexes, Triplexes, Fourplexes, or Patio Homes?*
Have you ever worked in new Tract Developments?*
Any current Wrap-Up/OCIP Projects?*
Have you ever worked in new Assisted Living Facilities?*
Have you, or will you, ever convert Apartments to Condominiums*
Any unusual exposures/operations not otherwise covered by this questionnaire?*

Additional Insured(s)

Have you allowed, or will you allow, your license to be used by any other contractor for a project on which you have worked?*
Has any other licensing authority taken any action against you?*

Losses and Claims

Are there any claims or legal actions pending against any of the entities?*
Do any of the entities named in the application have knowledge of any pre-existing act, omission, event, condition, or damages to any person or property that may potentially give rise to any future claim or legal action against them?*
Have you been accused of faulty construction in the past 5 years?*
Have you been accused of breaching a contract in the past 5 years?*
Have you ever filed any Mechanic Liens in the past 5 years?*

Finish

Consumer Disclosure*
All the above statements made by me in this form are accurate and true to the best of my ability.
Clear Signature
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.
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