Business Entity Type *
Select Type
Sole Proprietorship
LLC
Partnership
Corporation
S-Corporation
Joint Venture
Years in Business *
Select
New Business (less than 1 year)
1-2 years
3-5 years
6-10 years
11-20 years
20+ years
Primary Contractor Classification *
Select Primary Classification
General Contractor - Residential
General Contractor - Commercial
General Contractor - Industrial
Design-Build Contractor
Construction Manager
Framing Contractor
Roofing Contractor
Siding Contractor
Masonry / Brick Contractor
Concrete Contractor
Foundation Contractor
Structural Steel Contractor
Demolition Contractor
Drywall / Plaster Contractor
Painting Contractor
Flooring Contractor
Tile Contractor
Finish Carpentry / Millwork
Cabinet / Countertop Installer
Insulation Contractor
Ceiling / Acoustical Contractor
Electrical Contractor
Plumbing Contractor
HVAC Contractor
Fire Protection / Sprinkler
Low Voltage / Data / Security
Solar / Renewable Energy
Excavation Contractor
Grading Contractor
Paving / Asphalt Contractor
Utilities Contractor
Landscaping Contractor
Fencing Contractor
Pool / Spa Contractor
Window / Door Installer
Glass / Glazing Contractor
Waterproofing Contractor
Restoration / Remediation
Environmental / Abatement
Welding Contractor
Scaffolding Contractor
Other Specialty (describe below)
Describe Your Operations *
Customer Type - Percentage of Work
Maximum Working Height
Select
Ground Level Only
Up to 15 feet
15-30 feet
30-50 feet
Over 50 feet
Geographic Scope
Select
Local (one county)
Regional (multiple counties)
Statewide
Multi-State
Nationwide
General Liability Limit Needed *
Select Limit
$1,000,000 / $2,000,000
$2,000,000 / $4,000,000
Higher limits needed
Not sure - need guidance
Per Project Aggregate Needed?
Select
Yes
No / Not Sure
Additional Insured Endorsements?
Select
Yes - Frequently requested
Yes - Occasionally
No / Rarely
Waiver of Subrogation needed?
Select
Yes
No / Not Sure
Do you provide any warranty on your work?
Select
1 Year Warranty
2 Year Warranty
Extended Warranty (3+ years)
Varies by contract
No Warranty
Does the business own vehicles? *
Select
Yes
No
Hired & Non-Owned Auto needed?
Select
Yes - Employees use personal vehicles
No
Vehicle Schedule (Year, Make, Model, VIN)
Auto Liability Limit
Select
$500,000 CSL
$1,000,000 CSL
100/300/100 Split
Radius of Operations
Select
Local (under 50 miles)
Regional (50-200 miles)
Statewide
Multi-State
Workers' compensation covers medical expenses and lost wages for employees injured on the job. Construction work involves elevated injury risk, making proper coverage essential.
Job Classifications / Duties
List Major Equipment (over $10,000 value)
Where is equipment primarily stored?
Select
Locked Shop / Warehouse
Fenced Yard / Compound
Locked Vehicles / Trailers
Often left at job sites
Multiple locations
Umbrella Limit (if requested)
Select
$1,000,000
$2,000,000
$5,000,000
$10,000,000
$25,000,000+
Bond Amount (if needed)
Any claims in the past 5 years? *
Select
No claims
1-2 claims
3-5 claims
5+ claims
Current Insurance Status
Select
Currently insured - shopping
Renewal coming up
New business - first policy
Lapsed coverage
Being non-renewed
Claims Details (if applicable)
Preferred Contact Method
Select
Phone Call
Email
Text Message
Best Time to Reach You
Select
Early Morning (7-9am)
Morning (9am-12pm)
Afternoon (12-5pm)
Evening (after 5pm)
How did you hear about us?
Select
Google Search
Referral from another contractor
Referral from general contractor
Trade Association
Supplier / Vendor
Social Media
Trade Show / Event
I'm a current client
Other
Additional Comments or Special Requirements
