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Contractors Liability Quote
Limits of Liability Desired
Company Name: Owners Name
Contractor License Type: Contractor License Number(s)
Years of Experience: Years in Business
Type of Business:
Number of active Current Owners/Partners/Officers
State, Zip:
Gross Receipts Including Labor & Material & Cost of Sub:
Average value of projects:
Number of jobs running at same time:
Payroll excluding owners, officers and clerical, but Including leased Labor:
Number of full time field employees:
Number of part time field employees:

Indicate percentage of work performed
(Total should equal 100%):

% Remodeling
% Repair and Service
% Tenant Improvement
% New Construction

In What Capacity Do You Operate?
(Total should equal 100%):

% General Contractor
% Sub-contractor
% Owner/Builder/Developer
% Construction Management

The reason applying for insurance and additional Comments:

Will you use subcontractors?
Yes No
If yes, annual cost of sub including labor and material:

If yes, list trades of subcontractors used:

Are you or will you be involved in new ground up construction?
Yes No
  Describe your involvement in new ground up construction if any:

Indicate percentage of work performed:
(Total should equal 100%)

% Commercial
% Residential (Single Homes)
% Residential (Townhomes, Apts, Condos)
% Other

Prior and/or current insurance info:

Are you currently insured? Yes No
If yes, who is your current carrier?
Policy expiration date:
If no insurance, years without coverage:
Any claims in last 5 years?




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