subject_line
Contractors General Liability Quote Request
Contractors General Information
Company Name
*
Company Address
*
Company Phone Number
*
Company Point of Contact
*
Point of Contact Phone number
*
Point of Contact Email Address
*
Company Website (if any)
Type of Contractor
Contractor’s License Number
Company FEIN or Tax ID
Sales / Payroll / Subcontractors Information
Total Annual Gross Sales (Estimate)
Total Field Payroll (Estimate)
Total Subcontractors Cost (Estimate / If Any)
Type of Subcontractors Used (If Any)
Description of Operations & Policy Form Specifics
Brief Description of Operations
*
Specialty Endorsements and or Policy Forms Needed for Certificates of Insurance
Number of Additional Insured Endorsements Needed Per Year (estimated)
Give the total percentage of operations – Must equal 100%
Commercial / Residential / Industrial Work %
*
Commercial Work
Residential Work
Industrial Work
0/100 points
New Construction / Replacement / Repair and or Service Work %
*
New Construction
Replacement Work
Repair and or Service Work
0/100 points
Any New Construction Residential Work - Custom Homes
*
Yes
No
If so explain
Any New Construction Residential Work - Track Homes / Condos / Townhouses
*
Yes
No
If so explain
Any service work on Condos or townhouses?
*
Yes
No
If so explain
Any New Construction (Ground Up) Commercial Work
*
Yes
No
If so explain
Any New (Ground Up) Industrial Work
*
Yes
No
If so explain
List two current jobs or projects:
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