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Contractors Application Questionnaire Online

Trades Contractors

Contractor Insurance Application

Step 1 of 6

Business Name of Applicant*
Name of Applicant (Principals:)*
First Last
Full Postal Mailing Address*
Street Address City State / Province / Region ZIP / Postal Code
Website
Your Phone Number*
Email
Effective Date:*
Year Business Started:*
How many losses has the Insured had in the last 5 years?*
Current Insurer ( if None enter none )*
Has any insurer ever cancelled, refused or applied special terms to any similar insurance for Insured?*
If yes, please provide details:
Years of experience*
Business Address*
Street Address Address Line 2 City ZIP / Postal Code
Qualifications*
Licensed*
Do you assume liability under any hold harmless agreements or contracts?*
Provide details of most recent/largest project
Do you or any of your staff perform original design, inspection for fee, or consulting services?*
if yes please describe details:

Type of Contractor*
Building (Replacement Cost Value) $
Contents $*
Are any tools or equipment leased or rented from others ?*
Equipment storage location:
Are any pieces of equipment protected by tracking equipment (global positioning system locators)?*
LIABILITY Each Occurrence Limit*
Estimated Amount of Yearly Gross Receipts $*
Estimated Yearly Wages Including owners and Directors $*
What percentage of operation is Residential work?*
What percentage of operation is Commercial Work?*
What percentage of operation is Industrial ?
Does the Applicant handle, use or perform operations involving any of the following?*
If Yes Does the Applicant let or sublet any work to independent contractors?
Are independent contractors who perform work on behalf of the applicant required to carry commercial general liability insurance including products/completed operations coverage's?
If yes, what does the Applicant consider to be the minimum acceptable limit(s) of liability (i.e. amount of coverages)? (required)*
Are liability insurance certificates secured from all independent contractors before they are allowed to begin working?(required)*
Does the Applicant enter into formal contractual agreements with independent contractors?*

Blasting Liability Survey
In which areas do you operate?*
Number of Years Experience of Principal(s):*
Describe general nature of your operations (e.g. logging road or highway construction, urban blasting contractor, etc.):*
Municipal / Subdivision: %*
Remote Areas: %*
Gross Annual Receipts Derived From: Drilling $*
Gross Annual Receipts Derived From: Blasting $*
Gross Annual Receipts Derived From: Other $*
Number of Drilling Rigs Owned or Operated:*
Other Mobile Equipment (e.g. Loaders):*
Description of largest three projects you have successfully completed in the last twelve (12) months:*
Do You Engage In:*
Work at/near Mills?*
Demolition?*
Pipeline Work?*
Underwater Work?*
Is Pre-Blast Survey on Adjacent Properties Conducted?*
If YES, By Whom?*
What Limit of Clearspace is required for Usual Operations?*
Does Insured Use Seismograph to Monitor Vibrations?*
What is your usual method of preventing debris flying?*
Please provide copy Fire Safety & Prevention Manual.
SNOW REMOVAL SUPPLEMENT
# of Years in Business:*
# of Years Experience:*
Loss Experience (5 years) LIST ALL YOUR CLAIMS*
Current insurance company on risk?*
Are they renewing?*
Expiring premium: $
Snow estimated annual gross receipts snow removal, for Highways*
Snow estimated annual gross receipts snow removal, for Municipal Streets & Sidewalks $*
Snow estimated annual gross receipts snow removal, for Retail & Residential Properties ?*
Snow estimated annual gross receipts snow removal, for Institutional (Hospitals, Schools, etc)*
List 5 of your largest contracts:*
What limit of Third Party Liability insurance do you carry on your automobiles? $*
Does you automobile policy include coverage for attached machinery?*
Do you keep logbooks showing weather conditions, time, location and details of all work carried out?*
Do your contracts specify when work is to be performed?*
If “No”, who makes the decision – you or your client?*
Do you and your clients, where practicable, perform a pre-season and post-season survey to agree on the condition of the grounds/worksite (buildings, equipment, landscaping, etc.)?*
Is any work subcontracted?*
If “Yes”, do subcontractors carry separate CGL Insurance and what limits?
a) List Equipment to be insured – all items over $1,500 must be scheduled*

AFTER SUBMITTING YOUR FORM AND YOU RECEIVE THE MESSAGE One or more fields have an error. Please check THE FIELDS THAT ARE WRITTEN IN RED, COMPLETE THE MISSING INFORMATION ( IF NOTHING IS APPLICABLE ENTER NONE)and SUBMIT AGAIN. tHE FORM WILL ONLY BE SUBMITTING ONCE ALL FIELDS ARE COMPLETED. ONCE THE FORM HAS BEEN SUCCESSFULLY SUBMITTED YOU WILL SEE Thank you for your message. It has been sent.

PLEASE COMPLETE THE FORM FOR A QUICK QUOTE.

Contractors Application Questionnaire Online

Contractor Insurance Application

Step 1 of 6

Please select the type(s) of operations performed and indicate the values requested below:

Blasting Liability Survey

SNOW REMOVAL SUPPLEMENT