Artisan Contractor Insurance Quote

Quote Request

Complete the following information if you would like to obtain a quote. Please understand this is not an application. An application will be sent to you if coverage is desired.

All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.

Personal Information

*First Name
*Last Name
Business Name DBA
Business Address
City/St/Zip
*Phone Number
Alternate Number
*Email Address

Underwriting Information

What is the nature of your business?
Is the business a corporation, partnership, or sole proprietorship?  Corporation Partnership Sole Proprietorship
Number of owners
Number of Employees
Payroll of Owners
Payroll of Employees
Total annual gross receipts
Business License Number
License Type
Years of experience
Years operated under current name
Other business names?  Yes No
  If yes, what other names?
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?  Yes No
Do you construct footings or foundations which may support dwellings or other structures?  Yes No
Do you construct slab or monolithic floors?  Yes No
Do you construct piers or underpinning which may support dwellings or other structures?  Yes No
Do you construct retaining walls which may support dwellings or other structures?  Yes No
Do you construct fireplaces or chimneys?  Yes No
What is the percentage of work done as a General Contractor?
What is the percentage of work done as a Sub-Contractor?
What is the percentage of work done on Residential?
What is the percentage of work done on Residential?
What is the percentage of work done on Commercial?
What is the percentage of work done for Remodeling?
What is the percentage of work done for Renovation?
What is the percentage of work done for Repair or Maintenance?

Claims Information

Were there any losses or claims in the last 5 years?  Yes No
  If yes, what is the date, amount paid and description of each loss or claim?

Coverage Information

Current Insurance Company
How much are you paying now?
What is the liability limit requested?
What is the building limit requested?
What is the building deductible requested?
What is the business personal property (contents) limit requested?
What is the contents deductible requested?
What is the loss of income requested??
Questions or Comments
Best Time To Contact You
Please let us know the best time to call and discuss your quote  Morning Afternoon Evening Anytime Or Specify Other:
*Please prove you're human by entering the Captcha characters

captcha