To help us get started on a quote, please answer the questions below. Required fields are marked with an asterisk (*) What is your favorite color? Contact information Name: * Email: * Phone: * Business information Business name: * Is this name a DBA? * Yes No What is the address of your business? * Address City State ZIP Code I have a different mailing address. Add address Mailing address: * Address City State ZIP Code Describe your business: In what year was your company started? * Federal ID number: Coverage needs How many employees do you have? Full-time Part-time Does your business own any vehicles or trailers? * Yes No How much do you estimate the value to be of your tools in storage? $ How much do you estimate the maximum value to be of your tools on the job site? $ Payroll estimate for last 12 months: $ Payroll estimate for next 12 months: $ Gross receipts estimate for the last 12 months: $ Gross receipts estimate for the next 12 months: $ Who is your current insurance provider? Provider's name Policy number Do you own or lease your office building? Yes No Has your company had any losses in the last 5 years? Yes No In what year was your building built? What is the square footage of your building space? Does your business need to insure vehicles? Yes No Select all that apply: I am an owner of other properties or business operations under this legal entity. I am related to another entity through common ownership. I am a subsidiary of another entity? Work history Describe the last five jobs: Work completed*Project type*Start date*Completion date*Revenue*Client* Work completed * Project type * Start date * Completion date * Revenue * Client * Work completed Project type Start date Completion date Revenue Client Work completed Project type Start date Completion date Revenue Client Work completed Project type Start date Completion date Revenue Client Work completed Project type Start date Completion date Revenue Client E.g., Installed cabinet in restaurant | New commercial construction | MM/DD/YYYY | MM/DD/YYYY | $12,000 | General contractor I have current, completed or planned construction in AK, AZ, CA, HI, NV or NY. Specific state work Subcontractors Do you use subcontractors? * Yes No Estimate of amount paid to subcontractors in the last 12 months. * $ Estimate of amount to be paid to subcontractors for the next 12 months? * $ Is there a requirement that you be held harmless and indemnified for loss and defense costs caused by the work of subcontractors? * Yes No Do you obtain and keep a file of Certificates of Insurance for General Liability from all subcontractors? * Yes No Are subcontractors required to show you as an additional insured on the subs' General Liability policies? * Yes No Do your subcontractors carry General Liability limits less than you? * Yes No Do your subcontractors currently operate in the state of New York, or plan to in the future? * Yes No Submit