Contractors Quoting Questionnaire PhoneThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formSalespersonBusiness ProfileLegal Corporate NameDba NameLocation / Physical address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Year EstablishedBusiness EntityBusiness Entity TypeSelect...Individual PartnershipCorporationLLCJoint VentureAssociationOtherDoing Business As (DBA)Legal Entity NamePolicy Effective Date Year Business EstablishedPhone NumberEmail FEIN/TAX IDPrimary Contact InformationContact RoleSelect...AccountantBusiness OwnerBusiness PartnerCompany ExecutiveExecutiveLLC MemberOffice ManagerOtherContact Name First Last Phone NumberEmail Primary Contact Mailing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Completion of prior carrier and loss information is mandatory for the past 4 years of the applicant's business, if applicable.Has this business had any business insurance policy cancelled or non-renewed in the last 3 years? Yes No Has the current owner maintained continuous insurance coverage for the business? Yes No Select most recent prior insurance carrier:Current policy expiration date: Are loss runs available for the previous 4 years? Yes No Has any claim occurred in the last 4 years? Yes No Do you Own or Lease your Current Location Own Lease Read each statement carefully and check all that apply:Do your Subcontracts work to others. Yes No If Yes, Percentage of SalesDo you sell and/or install refurbished equipment of appliances. Yes No Do you install, repair, and/or service equipment for hospitals, medical centers, military facilities, medical research facilities, schools, or municipalities. Yes No Are you are engaged in design and/or architectural work. Yes No Do you perform excavation or trenching work to depths exceeding four feet below ground or that requires shoring. Yes No Do you or have you worked on new multi-unit residential construction projects with four or more units in the last 10 years or plans to in the future. Yes No Do you install or service solar panels or geothermal heating systems. Yes No Do you hold a contractors license for your trade. Yes No Building InformationYear Built:Construction type:Select...FrameStuccoBrick VeneerMasonryNon-CombustibleMasonry Non-CombustibleModified Fire ResistiveFire ResistiveRoof Type:Select...ShakeTileComposition ShingleFlat-RubberFlat-ThermoplasticBuilt-up BitumenBuilt-up Modified BitumenBuilt-up Tar-GravelMetalOtherNo of Stories:Fire Sprinkler System: Yes No IF Yes, Fire Sprinkler system w/Annual Maintenance:Select...FullPartialNoneType of Fire Alarm:Select...Central StationLocalNoneType of Burglar Alarm:Select...Central Station with KeysCentral Station without KeysLocalNoneProperty ValuesSquare Feet OccupiedBuilding Amount:Business Personal Property Amount:General Building/Location InformationHave there been any major renovations to the building since it was constructed? Yes No Heating/HVAC Year:Electrical/Wiring Year:Plumbing Year:Roof Year:Does you lease any units to others Yes No General Liability InformationNumber of Active Owners/Officers:Number of Non-Active Owners/Officers:Number of Full-Time Employees:Number of Part-Time Employees:Annual Revenues:General Liability PayrollEnter Trade Payroll below , do NOT INCLUDE OWNERS OR OFFICERS, SALES PERSONNEL, OR CLERICAL. Air Conditioning Systems or Equipment - Dealers or Distributors and Installation, Servicing or RepairAnnual PayrollAppliances and Accessories Installation, Servicing or Repair - CommercialAnnual PayrollAppliances and Accessories - Installation, Servicing or Repair - HouseholdAnnual PayrollCarpet and Upholstery CleaningAnnual PayrollCarpentry Finish Interior, Cabinet InstallationAnnual PayrollElectrical Work – Wiring within BuilidngsAnnual PayrollElectrical Work - Communication Equipment and Apparatus InstallationAnnual PayrollFence ErectionAnnual PayrollFloor Covering Installation – Carpet, Vinyl, Wood, Laminate, and LinoleumAnnual PayrollFurniture and Fixture Installation – Office and StoresAnnual PayrollGreenhouse ErectionAnnual PayrollHVAC Distributors, Installation and Servicing - No Liquefied Petroleum GasAnnual PayrollHVAC Distributors, Installation and ServicingAnnual PayrollInterior DecoratorsAnnual PayrollJanitorial Services CommercialAnnual PayrollJanitorial Services ResidentialAnnual PayrollLandscaping MaintenanceAnnual PayrollLandscape InstallationAnnual PayrollOrnamental Metal WorkTotal Annual CostPainting ResidentialAnnual PayrollPainting CommercialAnnual PayrollPaperhangingAnnual PayrollPlumbing - Commercial and IndustrialAnnual PayrollPlumbing - Residential or DomesticAnnual PayrollRefrigeration Systems or Equipment - Distributors, Installation, and Servicing - CommercialAnnual PayrollSheet Metal Work - OutsideAnnual PayrollSheet Metal Work – Interior OnlyAnnual PayrollSign Painting & Lettering Interior & ExteriorAnnual PayrollTile, Terrazzo, Marble and Mosaic – InteriorAnnual PayrollWater Softening Equipment - Installation, Servicing or RepairAnnual PayrollWindow Shade and Blind InstallationAnnual PayrollSecondary General Liability, enter total Annual Costs for any applicable below:Contractors - Subcontracted Work - Building Construction - Apartment/Office Buildings 4+ StoriesTotal Annual CostContractors - Subcontracted Work - Building Construction - One/Two Family DwellingsTotal Annual CostContractors - Subcontracted Work - Industrial UseTotal Annual CostContractors - Subcontracted Work - BuildingsTotal Annual CostOptional CoveragesContractors Installation Coverage Yes No AmountContractors Scheduled Tools and Equipment items over $2000 Yes No AmountContractors Tools and Equipment NON-OWNED or RENTED Yes No AmountEmployment Practices Liability Insurance Yes No AmountEmployee Benefits Liability Insurance Yes No AmountEmployee Tools Yes No AmountErrors and Omissions Yes No AmountPollution Liability Yes No AmountTo expedite your Proposal, we need loss History for Past Five years ( see the other raters )Loss History for the Past Five Years Drop files here or Select files Max. file size: 256 MB. We need this to provide discounts, and for Underwriting approval. Claims History – aka “loss runs” are ordered by you from your current Agent and/or Insurance Company. It is a good business practice to order these yearly. Loss History is only provided to Owner / Property Manager, we do not have access or authority to request these. Copies of your Property, Liability, and Umbrella Coverages, if any. Drop files here or Select files Max. file size: 256 MB. Consent(Required) I Agree to the Privacy Policy, Terms of Service, and to Receive Communications.
