Artisan Contractor | Insurance Savers Agency, Inc.

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Complete the following information if you would like to obtain an Artisan Contractor Insurance quote. Please understand this is not an application. An application will be sent to you if coverage is desired.
All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.

Personal Information

Select Your State

Please Note: We only write insurance for these states.

Address

What is your address?

Street Address Address Line 2 City State ZIP Code

Name*

What is your name?

First Last

Telephone Number (Business)*

What is your business telepone number?

Telephone Number (Home)

What is your home telepone number?

Email Address*

What is your email address?

Fax

What is your fax number?

Underwriting Information

Number of Owners

How many owners?

Please enter a number greater than or equal to 0.

Number of Employees

How many Employees

Please enter a number greater than or equal to 0.

Payroll of owners

What is the payroll amount of the owners?

Payroll of employees

What is the payroll amount of the employees?

Total Annual Gross Receipts

What is the total annual gross?

Total Annual Sub Costs

What are the annual sub costs?

Classification

What is your classification?

Contractors License Number

What is your contractors license number?

License Type

What is the license type?

Years of Experience

Years of experience in this business?

Please enter a number greater than or equal to 0.

Years Operated Under Current Name

How many years have you operated under your current business name?

Please enter a number greater than or equal to 0.

Other Business Names

Have you used any other business names during the past 5 years?

Yes
No

Construction or Remodeling

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?

Yes
No

Construct Foundations

Do you construct footings or foundations which may support dwellings or other structures?

Yes
No

Construct Floors

Have you used any other business names during the past 5 years?

Yes
No

Construct Piers

Do you construct piers or underpinning which may support dwellings or other structures?

Yes
No

Retaining Walls

Do you construct retaining walls which may support dwellings or other structures?

Fireplaces or Chimneys

Do you construct fireplaces or chimneys?

Percentage as General Contractor

What is the percentage of work done as a General Contractor?

Percentage as Sub-Contractor

What is the percentage of work done as a Sub-Contractor?

Percentage on Residential

What is the percentage of work done on Residential?

Percentage on Commercial

What is the percentage of work done on Commercial?

Percentage on Remodeling

What is the percentage of work done for Remodeling?

Percentage for Renovation

What is the percentage of work done for Renovation?

Percentage for Repair or Maintenance

What is the percentage of work done for Repair or Maintenance?

Claims Information

Were there any losses or claims in the last 5 years?

Losses - Claims

Yes
No

What is the date, amount paid and description of each loss or claim?

Coverage Information

What is the current insurance company?

Amount Current Coverage

How much are you paying now?

Liability Limit

What is the liability limit requested?

Loss of Income Coverage

What is the loss of income requested?

Questions, Comments or Additional Coverage

Are there any questions, comments or additional coverage required?

Captcha

PLEASE NOTE: Insurance coverage cannot be bound without a written binder from our office.

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