Artisan Contractor Insurance
Personal Information
Last Name
*
First Name
*
Business Name
Street Address
City
State
Zip Code
Phone Number
Alternate Telephone
Fax Number
Email Address
*
Underwriting Information
Number of owners
Payroll of Owners
Payroll of Employees
Total annual gross receipts
Total annual sub costs
What is your classification?
Plumber
Electrician
Landscaper
Mason
Dry Wall
Roofing
Carpentry
Kitchen and Bath
Doors and Windows
Other
If other, please describe
Contractors License Number
License Type
Years of experience
Years operated under current name
Do you construct fireplaces or chimneys?
Yes
No
What is the percentage of work done on Residential?
What is the percentage of work done on Commercial?
What is the percentage of work done for Remodeling?
What is the percentage of work done for Renovation?
What is the percentage of work done for Repair or Maintenance?
Claims Information
Were there any losses or claims in the last 5 years?
Yes
No
If yes, what is the date, amount paid and description of each loss or claim?
Coverage Information
Current Insurance Company
How much are you paying now?
What is the liability limit requested?
-select-
$300,000/$600,000
$500,000/$1,000,000
$1,000,000/$2,000,000
Questions or Comments
Best Time To Contact You
Please let us know the best time to call and discuss your quote.
Morning
Afternoon
Evening
Anytime
Or Specify Other:
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