Contractor Liability Insurance Quote

Coverage & Company Information

Limits of Liability

Company Name *

Owner's Name *

Type of Business *

Number of Active Owners/Partners/Officers *

License Information

License Type *

License Number *

Years of Experience *

Years in Business *

Contact Information

Street Address *

City *

State, Zip *

Phone *

Fax

Email Address *

Business Financials

Gross Receipts *

Avg. Project Value *

Jobs at Same Time *

Annual Payroll *

Full-Time Employees *

Part-Time Employees *

Work Breakdown

% Remodeling

% Repair & Service

% Tenant Improvement

% New Construction

Operations Capacity

% General Contractor

% Sub-contractor

% Owner/Builder

% Construction Mgmt

Project Types

% Commercial

% Residential (Homes)

% Residential (Multi)

% Other

Subcontractors

Will you use subcontractors? *

Yes No

Annual Sub Cost

Trades of Subs Used

New Construction

Involved in ground-up construction? *

Yes No

Describe involvement:

Insurance History

Currently insured?

Yes No

Current Carrier

Expiration Date

Years Without Coverage

Claims (Last 5 Years)

Additional Information

Reason for applying & additional comments *

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