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Quote Application
Applicant
Business Underwriting Information
Applicant
*
Nature of Business
select
Apartments
Condominiums
Contractor
Institutional
Manufacturing
Office
Restaurant
Retail
Service
Wholesale
Оther
*
Trade
select
Air Conditioning
Appliance Installation - Commercial
Appliance Installation - Household (residential)
Carpentry - Commercial
Carpentry - Handyman
Carpentry - Interior
Carpentry - Residential
Carpet-Upholstery Cleaning
Ceiling/Wall Installation - Metal
Communication Equipment Installation
Concrete Construction
Conduit Construction - Cable/Wire
Debris Removal - Construction Site
Door/Millwork Installation - Metal
Drilling - Water
Driveway/Sidewalk Paving
Drywall
Electrical - Within Buildings
Excavation
Fence Erection
Floor Covering - No Tile
Grading
Heat/AC no LPG
House Furnishing Installation
Janitorial - Commercial
Landscaping Gardening
Masonry
Metal Erection - Decorative
Paint Exterior (3 stories & Under)
Paint Interior
Paperhanging
Plaster/Stucco
Plumbing Commercial
Plumbing Residential
Prefabricated Building Erection
Refrigeration Equipment Installation/Service
Satellite Dish Installation
Septic Tank Cleaning
Septic Tank Installation
Sewer Mains Construction
Siding and Gutter Installation
Sign Painting
Tile/Stone Installation
Water Mains Construction
*
Your Name
*
Business Name
*
Mailing Address
*
City
*
State
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Add New
*
ZIP
*
E-mail
*
Phone
*
Fax
(optional)
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Business Underwriting Information
*
Type of operation
select
Carpentry
Masonry
Remodelling
- - - - - - - - - - -
Air Conditioning
Appliance Installation - Commercial
Appliance Installation - Household (residential)
Carpentry - Commercial
Carpentry - Handyman
Carpentry - Interior
Carpentry - Residential
Carpet-Upholstery Cleaning
Ceiling/Wall Installation - Metal
Communication Equipment Installation
Concrete Construction
Conduit Construction - Cable/Wire
Debris Removal - Construction Site
Door/Millwork Installation - Metal
Drilling - Water
Driveway/Sidewalk Paving
Drywall
Electrical - Within Buildings
Excavation
Fence Erection
Floor Covering - No Tile
Grading
Heat/AC no LPG
House Furnishing Installation
Janitorial - Commercial
Landscaping Gardening
Masonry
Metal Erection - Decorative
Paint Exterior (3 stories & Under)
Paint Interior
Paperhanging
Plaster/Stucco
Plumbing Commercial
Plumbing Residential
Prefabricated Building Erection
Refrigeration Equipment Installation/Service
Satellite Dish Installation
Septic Tank Cleaning
Septic Tank Installation
Sewer Mains Construction
Siding and Gutter Installation
Sign Painting
Tile/Stone Installation
Water Mains Construction
*
Business Type
LLC
Corporation
Individual
Partnership
*
Describe typical projects
*
Limit of Liability Coverage Requested
select
$300,000
$500,000
$1,000,000
$2,000,000
select
$1,000,000
$500,000
$2,000,000
$3,000,000
$5,000,000
*
Proposed coverage date
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Currently Insured
Yes
No
*
Name of Carrier
*
How Long Insured
select
< 1 Year
1-2 Years
2-3 Years
3-4 Years
4-5 Years
> 5 Years
*
Prior Claims
Yes
No
Claim type
Date
Claim type
select
Fire / smoke
Water (non-weather related)
Weather-related water
Other weather (wind, hail, hurricane)
Dog bite liability
Other liability (slip / fall and other)
Theft / burglary / vandalism / malicious mischief
All other
Date
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*
Date business started
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*
Years in business
*
Years in field
*
% of work
residential
*
% of work
commercial
*
Number of Active Owners
*
Number of Employees
*
Annual Employee Payroll
*
Annual Gross Sales
*
Do you subcontract work
Yes
No
*
% of Gross Sales Subbed
*
Kind of work
Any work prior to Certificate of Occupancy?
Yes
No
*
Comments / Remarks
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