Contractor General Liability Insurance

Artisan Contractors Policy QUOTE

At NEC Insurance Agency, Inc. We put the power of the Internet to work for you!
The following questions concern the type of business insurance coverage you are requesting . Please answer them as accurately as possible.
Business Information:



1. Business Name:    

What type of entity is your company?    

2. Description of the business:    

How many years in business?    

3. Business address:    

City:    

State:      

Zip Code:        

4. Please indicate the state in which your business is located:

5. Do you currently have insurance? Yes No

6. If yes, please provide the company name here:    

7. How many years have you had coverage with this company?    

8. How many years have you had continuous coverage (With no lapse)?    

9. In the past five years have you reported any losses?      Yes No

10. If you have, were those claims:    

11. Describe all operations in details:

    

  %Painting

  %Carpentry 

  %Drywall 

  %Electrical 

   %Plumbing

   %Masonry

  % %Door, Window, Partition Install/Repair     

  %Cabinet Making/Install

  %Woodworking

%    Other

12. Commercial Work, in offices       %

    Any other Commercial Work       %

    Residential Work       %

13. Inside Buildings       %

    Vs. Outside Buildings        %

14. Is More than 5% of work is performed outside of " Home " State?      Yes No

15. Any other business owned by applicant, including any unrelated operations?

 Yes No      IF Yes, please List     

16. Any work involving:

Sewers & Drains  Yes No

Heating / Air-conditioning  Yes No

Exterior Work above 3 stories  Yes No

Tree Pruning / Spraying  Yes No

Medical or life Support  Yes No

Snow / Ice Removal  Yes No

Alarms  Yes No

Lawn Sprinklers  Yes No

Fire Sprinklers  Yes No

Backhoes Yes No

Cranes Yes No

Roofing Yes No

Below Grade Work Yes No    If yes, Maximum Depth:    

17. Liability Amount:    

     Deductible:    

18. Property: $  

     Business Contents:    

19. Please indicate your total # of full-time employees:    

     Total Salary? $     

20. Please indicate your total # of Part Time Employees:     

     Total Salary? $     

21. Please indicate the payroll of the owners: Total Salary?   $     

22. Please indicate your total annual payroll without owners:   $     

23. Please indicate your total Gross receipts:   $  & nbsp;  

24. Please indicate your total Cost of Subcontractors:   $     

The answer to these basic questions will help us process your information.

1) Best Time To Contact:    

2) Additional Comments:
Please provide any additional information you feel is pertinent to the insurance coverage you need.

    

1. First Name:     

2. Last Name:      

3. Phone:              

4. Email:               

5. Address:          

6. Address:          

7. City:                   

8. State:                

9. Zip Code: