General Contractor / Artisan Contractor Application

Before you start filling out this application, to save you time, please read the requirements below. If you don't have ALL of the requirements fulfilled we CANNOT bind the policy. To save you and us time, please make sure that you have, or know that you can get, these requirements BEFORE you submit.

  • Loss Runs Attached - 3 Years Minimum
  • Proof of Prior Insurance - 3 Years Minimum
  • Payroll Documentation (DE7, P&L, Tax Return)
  • Sub Contractor Documentation
  • Signed Application

Broker Information:
Broker Name:
Contact Person:
Contact E-Mail Address (required):
Address:
City, State and Zip:
Phone:
Fax:
General Information:
Ownership Type:
FEIN or SSN:
Applicant:
Mailing Address:
City, State & Zip:
Phone:
Mobile:
Fax:
E-Mail Address:
License #:
License Type:
Within Municipal City Limits:
Location of Premises:
Physical Address:
City:
State:
Zip:
County:
Inspection Contact Information:
Contact:
Phone:
Mobile:
E-Mail:
Underwriting Information:
Number of Years in Business:
Number of Years Experience:
Projected Annual Gross Receipts:
Last Year's Annual Gross Receipts:
Will you have any projects that exceed $1,000,000?
Eligibility Requirements:
1. Do you work on condominiums, townhouses, apartments or tracts over 5 units except for repair or remodeling of not more than one unit within a development? Yes No
2. Are you a Contractor who works on student housing, senior housing, assisted living facilities or retirement homes except for repair or remodeling of not more than one unit within a development? Yes No
3. Are you a custom home builder who builds more than 5 homes in any one year? Yes No
4. Are you a contractor engaged in any structural work including grading and excavation on slopes of greater than 30 degrees, where the retaining wall may not exceed 6 feet in height? Yes No
5. Do you have more than one closed construction defect claim? Yes No
6. Do you have any one claim, with payments or reserves in excess of $10,000? Yes No
7. Do you have any open construction defect claims? Yes No
8. Are you a General contractor or developer performing new home construction or residential remodeling that are new ventures? Yes No
9. Are you a General contractor or developer performing new home construction or residential remodeling that has not had general liability coverage for at least the past 12 months? Yes No
10. Will you sell, install, service or repair alarm systems, automatic fire extinguishing systems, boilers, elevators, escalators, surveillance systems or TV monitoring systems, either commercial or residential? Yes No
11. Will you sell, install, service or repair wood, coal or waste oil burning stoves? Yes No
12. Will you remove asbestos insulation or asbestos containing material, fungus, mold or install insulation materials other than fiberglass or rock wool? Yes No
13. Are you involved in the sale of chemicals, or the application of chemicals, such as herbicides or pesticides, to property? Yes No
14. Do you perform work for petroleum, industrial, or chemical facilities? Yes No
15. Have you had more than 2 claims in 3 years? Yes No
16. Contractors with operations/work on or for airport, elevator, environmental remediation, railroad, roofing, swimming pool construction, traffic lights, underground tanks, skylights, EFIS. Yes No
17. Are you involved in fiber optic cable work or installation? Yes No
18. Are you involved in tunnelling? Yes No
19. Are you involved in any exterior work over five (5) stories in height? Yes No
20. Have you been personally bankrupt or the principal in a company that has been bankrupt the past five years? Yes No
21. Are you involved in recreational or playground construction? Yes No
22. Do you have any officer, owner, or partner has a prior felony conviction? Yes No
23. Premises - Are either gasoline, lumber, paints, stains, varnish, or lacquer stored at any job site or location? Yes No
24. Equipment - Are any of the applicants'/insureds' vehicles or contracting equipment over 5 years old? Yes No
25. Classification - Has the applicant/insured been in business for 5 years or less? Yes No
26. Employees - Do any applicants/insured employees work over 40 hours per week? Yes No
27. Cooperation - Do all employees receive safety and OSHA training? Yes No
28. Do you sub-contract work? Yes No
29. List the type of work subcontracted:

30. Check the type of subcontractor agreement you typically sign:

Standard (AGC, AIA Contracts) Custom Other
31. Do you obtain Certificates of Insurance from all subcontractors? Yes No
32. Do you monitor expiration dates shown on Certificates of Insurance? Yes No
33. Are you named as an Additional Insured on all subcontractors' policies? Yes No
34. Do you require all subcontractors to carry primary limits equal to or greater than your own? Yes No
35. Do you use written subcontractor agreements containing hold harmless indemnity agreements in your favor? Yes No
36. Does legal counsel or the insurance agent review all contracts? Yes No
Prior Coverage:
Prior Carrier:
Policy Number:
Expiration Date:
Business Classification:
General Contractor Classification
Please select your primary operation by classification.

Carpentry - Construction of Residential Property not exceeding 3 stories in height. (Residential Home Builder)

Carpentry NOC - Large Residential - Commercial
Anticipated Payroll
Sub Contractor Classifications
Please input sub cost into the corresponding sub contractor classification below.
Anticipated Sub Cost:
 91581 - Contractors - subcontractors work - in connection with construction, reconstruction, erection or repair - Not Buildings.
Anticipated Sub Cost:
 91582 - Contractors - subcontractors work - in connection with building construction, reconstruction, or erection - Apartment or office buildings over 4 stories.
Anticipated Sub Cost:
 91583 - Contractors - subcontractors work - in connection with building construction, reconstruction, or erection - One or Two Family Dwellings
Anticipated Sub Cost:
 91585 - Contractors - subcontractors work - in connection with building construction, reconstruction, or erection - Buildings
Payment Options:
Full Pay
25% Down - 3 Payments
25% Down - 5 Payments
Submission Request for Bind Checklist

Thank you for your business. In order to expedite your request
more efficiently, we will nee the following information:

  • Loss Runs Attached - 3 Years Minimum
  • Proof of Prior Insurance - 3 Years Minimum
  • Payroll Documentation (DE7, P&L, Tax Return)
  • Sub Contractor Documentation
  • Signed Application
  • Down Payment Check
  • All of the above are required to bind coverage.

Additional Comments:
    
Applicant Signature/Print Name
Agent/Producer Signature/Print Name