Contractors Insurance Quote Request
CONTRACTORS
Complete Supplemental Questionnaire
Applicant* Is the questionnaire for New business
Renewal business
Mailing Address* If renewal give current policy number
INSURED
1. When did the applicants Business Start?
2. How long the applicant been in this line of work
3. Is or has the applicant ever been involved in any other business venture as an owner or officer yes no
4. Has this business or any other business in which the insured is or was involved as an owner or officer ever declared bankruptcy yes no
5. What classes of contractors licenses does the applicant hold
6. License Numbers(s)
Does the applicant retain job files yes no
7. List the owners, partners or officers of the applicants business
Full Name Birth Date Title Time with this business
EMPLOYEES
1. Provide the following informations concerning employees for the past three years and give an estimate for next 12 months.
Year no of Full-time no of Part-time Number of seasonal employees
Estimate
2. Describe the training programs used for employees
3. The applicant is Union non-union Open shop
PAYROLL AND RECEIPTS
Provide the following informations for the past three years (use audited information if possible) and give an estimate for the next 12 months
Year Total receipts Payroll (excluding owners, partners and officers)
Estimate
OPERATIONS
1. Describe the last 5 projects completed (nature of work ,job length, dollar size etc). Any habitational projects in past 5 years? if so what? List general contractors for whom you obtained an additional insured endorsement on these projects
2. Is the applicant a general contractor yes no
3. Are any of the applicants employees qualified by education or licensed as architects, engineers, surveyors, draftsman or realestate agents / brokers yes no
4. Does the applicant offer any type of warranty yes no
5. Does the applicant intend to expand the business operations in the next year yes no
6. What is the radius of the applicants working area?
Which states does this include?
7. Has the applicant performed other types of construction in the past? yes no
8. What is the approximate breakdown of the applicants work
If habitational new construction
Multi family incl. Apts, Condos, townhomes
Custom Single Family
Tract Housing / Large development Single-Family
9. Has the applicant been involved with OCIP / Wrap-up projects yes no
10. Does the applicant currently do or has the applicant everdone any of the following? yes no
If yes Explain
SUBCONTRACTING AND SUBCONTRACTED WORK
1. Does the applicant hire subcontractors yes no
2. What type of operations does the insured subcontract out
3. Does the applicant require a certificate of insurance from subcontractors yes no
Is a minimum limit of liability requires yes no
what limit
4. Does the applicant ask to be named as an additional insured on the subcontractors general liability policy yes no
5. What is the total cost of subcontracted work on an annual basis
LOSS CONTROL
1. Describe the applicants loss control or safety program
2. Does the applicant require an employment application to be completed by prospective employees yes no
3. Does the applicant obtain MVRs for new employees yes no
4. Does the applicant obtain pre-employment physicals for new or prospective employees yes no
5. Does the applicant always check with all local utilities before digging yes no
CLAIMS OR LAWSUITS
1. Have there ever been any claims made or lawsuits filed against an applicant as a result of their contracting operations yes no
2. Have there ever been any claims made or lawsuits filed against an applicant as a result of alleged breaches of warranty in relation to work performed by the applicant yes no
3. Are there any known or apparent claims pending or potentially pending against the applicant as a result of contracting operations,including allegations of breach of warranty in relation to work performed by the applicant yes no
4. Are there any lawsuits pending or potentially pending against the applicant as a result of contracting operations,including allegations of breach of warranty in relation to work performed by the applicant yes no
5. Explain all "yes" answers to these questions      
Comments (include any additional information which may assist the underwriter in evaluating the applicant)
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