Artisan Contractors

Artisan Contractor

Artisan Contractor
Insurance Quote Form

Please complete the following form and click the "Send Quote"
button to submit for a free Quote.

Name
Mailing Address
City
State
Zip Code
Telephone 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 - MAINTENANCE:
Losses-Claims in the last 5 years:
*If yes, Date, Amount Paid & Description of each* Loss-Claim**
Liability Limits Requested:

UNDERWRITING INFORMATION