Contractors Insurance QuoteKarin Saroyan2024-05-15T05:53:28-08:00

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Application Information

Applicant Name*

First Last

Email*

Phone*

Can we text you?*

Yes

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Business Information

Proposed Policy Effective Date*

Legal Business Name*

Business Structure*

DBA

FEIN

Business Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address*

Same as Business Address

License Information

Contractors License or Application Fee Number

No license required

Classifications

Choose your primary class code. You may add up to 4 additional class codes to describe your business.

Class Code 1*

Class Code 1: % of Work*

Please enter a number from 0 to 100.

Add 2nd class code

Class Code 2

Class Code 2: % of Work

Please enter a number from 0 to 100.

Add 3rd class code

Class Code 3

Class Code 3: % of Work

Please enter a number from 0 to 100.

Add 4th class code

Class Code 4

Class Code 4: % of Work

Please enter a number from 0 to 100.

Add 5th class code

Class Code 5

Class Code 5: % of Work

Please enter a number from 0 to 100.

Total % of Work

Percent must add up to 100

Business Information

How many years has the applicant's current company been in business?*

Applicant's industry experience*

Insurance History*

Number of Active Owners*

Annual Gross Receipts*

Does Applicant Have Employees?

Yes

Number of Employees*

Please enter a number greater than or equal to 1.

Annual Employee Payroll*

Does Applicant Hire Subcontractors?

Yes

Annual Subcontractor Costs*

Percent of RESIDENTIAL work performed*

Please enter a number from 0 to 100.

Does Applicant perform residential work prior to the certificate of occupancy?

Yes

Percent of NEW work performed*

Please enter a number from 0 to 100.

*prior to approval for occupancy.

Percent of REMODELING work performed*

Please enter a number from 0 to 100.

*prior to approval for occupancy.

Total*

Percent must add up to 100

Please briefly describe your business*

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All the above information is accurate and true to the best of my knowledge*

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