Electrical Contractor Insurance Quote

Contact Name *

Title / Position

Email Address *

Phone Number *

City *

State * Select AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY DC

Zip Code *

Website

Federal Tax ID (EIN)

Years in Business * Select New / Startup Less than 1 year 1-2 years 3-5 years 6-10 years 11-20 years 20+ years

Business Entity Type * Select Sole Proprietorship Partnership LLC Corporation S-Corporation

Contractor License Number *

License Type Select Master Electrician Journeyman Electrician Electrical Contractor (C-10 or equiv) Low Voltage / Limited Energy General Contractor with Electrical Multiple Licenses

Annual Gross Revenue * Select Under $100,000 $100,000 - $250,000 $250,000 - $500,000 $500,000 - $1 million $1 million - $2 million $2 million - $5 million $5 million - $10 million $10 million+

Annual Payroll *

% Subcontracted Out Select 0% (No subcontractors) 1-10% 11-25% 26-50% Over 50%

Do you require COIs from subs? Select Yes - Always Yes - Sometimes No N/A - No Subcontractors

Residential - New Construction Residential - Remodel / Repair Commercial - New Construction Commercial - Tenant Improvement Industrial / Manufacturing Service / Maintenance Calls Panel Upgrades / Service Changes EV Charger Installation Solar / PV Installation Generator Installation / Service Fire Alarm Systems Security / Low Voltage Data / Telecom Cabling Lighting / Controls HVAC Electrical Underground / Trenching High Voltage (over 600V) Traffic Signals / Street Lighting

% Residential Work Select 0% 1-25% 26-50% 51-75% 76-100%

% Commercial Work Select 0% 1-25% 26-50% 51-75% 76-100%

% Industrial Work Select 0% 1-25% 26-50% 51-75% 76-100%

Largest Single Project Value Select Under $25,000 $25,000 - $50,000 $50,000 - $100,000 $100,000 - $250,000 $250,000 - $500,000 $500,000 - $1 million $1 million+

Maximum Height Worked Select Under 15 feet 15-30 feet 30-50 feet Over 50 feet

Work on energized circuits (live work)? Select Never Rarely (troubleshooting only) Sometimes Frequently

Total Employees *

Licensed Electricians

Apprentices

Office / Admin Staff

Experience Modification Rate (EMR)

Written Safety Program Regular Safety Meetings OSHA 10 / OSHA 30 Training Arc Flash Training NFPA 70E Compliance Lockout / Tagout Training Fall Protection Training PPE Required (safety glasses, hard hats) Drug Testing Program Employee Background Checks

Company Vehicles

Trailers

Bucket Trucks / Lifts

Tools & Equipment Value

Do employees use personal vehicles? Select No - Company vehicles only Yes - Sometimes Yes - Regularly for work

Owned or Leased Office/Shop Space? Select Home-based Leased Office / Shop Owned Building

Contents Value at Location

General Liability Workers' Compensation Commercial Auto Inland Marine / Tools & Equipment Umbrella / Excess Liability Professional Liability / E&O Business Property / BOP Builders Risk Surety / Contractor Bonds Cyber Liability Hired / Non-Owned Auto Employment Practices Liability (EPLI)

Desired Effective Date

Current Policy Expiration

Current Insurance Carrier

Current Annual Premium (approx)

Any claims in the past 5 years? * Select No claims 1-2 claims 3-5 claims More than 5 claims

Has coverage been cancelled or non-renewed? Select No Yes

Any OSHA violations? Select No Yes (explain below)

Any license violations or complaints? Select No Yes (explain below)

Preferred Contact Method Select Phone Call Email Text Message Any method is fine

Best Time to Reach You Select Morning (8am-12pm) Afternoon (12-5pm) Evening (after 5pm) Anytime