Landscaper Contractor Insurance

CONTRACTOR INSURANCE: 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.We have other insurance program worksheets you can select from the InsuranceCompany.com main menu option or clicking on the InsuranceCompany.com logo to the right. 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.