Contractor Insurance Quick Quote

Contractor Insurance Quick Quote Form

Submit this form to receive a commercial contractor insurance quote.

Business Information

Coverage Limits Requested *

Legal Business Name *

DBA (Doing Business As)

Business Owner First Name *

Business Owner Last Name *

Phone Number *

Email Address *

Business Address *

EIN (Employer Identification Number) *

Years of Experience in this Trade *

Years Business Has Been Operating *

Operations

Please provide information about your contractor operations and type of work.

Primary Trade / Work Performed *

Describe Your Operations *

SRevenue Information

Please provide your estimated revenue, payroll, employee count, and subcontracted work information.

Estimated Gross Revenue (Next 12 Months) *

Total Payroll (if employees) *

Number of Employees *

Estimated Cost of Subcontracted Work *

Project Information

Please provide information about the type and size of projects your business handles.

Type of Work *

ResidentialCommercialBoth

Type of Projects *

New ConstructionRemodel / RenovationRepair Work

Average Project Size ($) *

Largest Project Completed ($) *

Subcontractors

Please provide information about your use of subcontractors.

Do you subcontract work? *

YesNo

Percentage of Work Subcontracted *

Do subcontractors carry their own insurance? *

YesNo

Do you obtain Certificates of Insurance from subcontractors? *

YesNo

Special Exposures

Please select any special exposures that apply to your business operations.

Do you perform any of the following? *

Work below gradeSynthetic stucco / EIFSMold remediationHazardous material removalWork at refineries / chemical plantsWork on bridges or highways

Safety & Claims

Please provide information about your safety program and claims history.

Do you have a formal safety program? *

YesNo

Has any insurance policy been cancelled or non-renewed in the last 5 years? *

YesNo

If YES, please explain

Any claims or lawsuits in the past 5 years? *

YesNo

If YES, please explain

Required Documents

Please upload your current insurance documents, if available.

Upload Current Loss Runs (3-5 Years) *

Upload Current Insurance Policy or COI (if available)

Signature

Please provide the applicant information and digital signature to submit your quote request.

Applicant First Name *

Applicant Last Name *

Title *

Digital Signature *

Date *

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