Contractor Insurance

CONTRACTOR INSURANCE; ARTISAN CONTRACTOR: Small independent contractors with payroll less than $150,000 and gross receipts less than $300,000. Examples: Carpet Cleaning, Carpentry, Concrete Pumpers, Gardeners, Handyman, Janitorial, Masonry, Painters, Plastering-Stucco, Plumbers, Window-Door Installation, etc... Please complete the Artisan Contractor Worksheet below to receive an insurance proposal. If you have an in-home business please select the home business option. If you have a larger company, manufacturing, industrial or need premise liability to satisfy your landlord insurance requirements please select the commercial general liability option. If you have a small to medium retail type operation, shoe store, florist shop or beauty salon please select the business owner policy option.

ARTISAN CONTRACTOR WORKSHEET
First Name:
Last Name:
Business Name:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
E-Mail Address:

UNDERWRITING INFORMATION
Number of Owners:
Number of Employees:
Payroll of Owners:
Payroll of Employees:
Total Annual Gross Receipts:
Total Annual Sub Costs:
Current Insurance Company:
Select Your Classification:
Contractors License Number:
License Type:
Years of Experience:
How many years have you operated under your current business name:
Have you use any other business names during the past 5 years:	NoYes
Have you been involved in the original construction or remodeling of town homes, condos, row homes or developments of 15 or more unattached single family dwellings during the past 5 years:	NoYes
Do you construct footings or foundations which may support dwellings or other structures:	NoYes
Do you construct slab or monolithic floors:	NoYes
Do you construct piers or underpinning which may support dwellings or other structures:	NoYes
Do you construct retaining walls which may support dwellings or other structures:	NoYes
Do you construct fireplaces or chimneys:	NoYes
Percentage % of work done as a GENERAL CONTRACTOR:
Percentage % of work done as a SUB-CONTRACTOR:
Percentage % of work done on RESIDENTIAL:
Percentage % of work done on COMMERCIAL:
Percentage % of work done for REMODELING:
Percentage % of work done for RENOVATION:
Percentage % of work done for REPAIR - MAINTANENCE:
Losses-Claims in the last 5 years:
*If yes, Date, Amount Paid & Description of each* Loss-Claim**
Liability Limits Requested:

ARTISAN CONTRACTOR WORKSHEET

UNDERWRITING INFORMATION

Copyright 1997-2003. Del Amo. All rights reserved.

Copyright 1997-2003. Del Amo. All rights reserved.