Get a Quote

Please complete the form below or call us at 1-800-622-7370 for your quick quote indication.

Type of Business/Organization:*
Please continue to the next page.
Contact Information
General Liability and Workers Compensation available only in DC, FL, GA, IN, MD, MS, NC, PA, SC, TN, VA. Click here for a Builders Risk/Course of Construction Insurance quote (available in all states except HI and AK).
Organization Name*
Contact Name
First Last
Address:
Street Address City State ZIP Code
Email:*
Website:
Daytime Phone
Operations
Please provide several sentences to describe in detail your operations and typical jobs.*
Please provide several sentences to describe in detail your business operations.*
Please provide several sentences to describe in detail your operations and the types of products that you sell.*
Operations Information
Years Of Operation Under Current Business Name:*
If none, please enter 0.
Please provide several sentences to describe in detail your operations and/or products.*
Are you a startup?*
- Yes
- No
Do you currently have insurance?*
- Yes
- No
Reason for seeking a quote*
Please indicate the policy types for which you are requesting a quote:
- General Liability
- Errors & Omissions
- Auto
- Property
- Worker's Compensation
- Equipment
- Builder's Risk
- Directors & Officers Liability
- Employment Practices Liability
- Cyber Risk
- Other
Business Entity Type:
Type of Contractor:*
Years Of Experience By Owner(s) In This Field:*
If none, please enter 0.
% of Work Residential:*
% of Work Commercial:*
Do You Have Employees Other Than Owners?*
- Yes
- No
Do You Use Uninsured Subcontractors?*
- Yes
- No
Do You Use Insured Subcontractors?*
- Yes
- No
Owners
Name*
Work Description
Estimated Annual Payroll*
Example: John Smith
Executive Supervisor
$45,000
W-2 Employees Who Are Not Owners
Please enter "none" in all 3 boxes on the first line if there are no W-2 employees who are not owners.
Work Description*
# of Employees*
Estimated Annual Payroll*
Example: Framing
3
$80,000
1099 Uninsured Subcontractors
Work Description/Classification*
Estimated Annual Amounts Paid*
Example: Land Clearing
$110,000
Insured Subcontractors
Estimated Annual Amounts Paid To All Insured Subcontractors Combined*
If none, please enter "none" in the field.
Types of Policies To Be Quoted
General Liability*
- Yes
- No
Current General Liability Carrier:
Current General Liability Premium:
Workers' Compensation:*
- Yes
- No
Current Workers' Compensation Carrier:
Current Workers' Compensation Premium:
Builders Risk:*
- Yes
- No
Current Builders Risk Carrier:
Current Builders Risk Premium:
Auto:*
- Yes
- No
Current Auto Carrier:
Current Auto Premium:
Property:*
- Yes
- No
Current Property Carrier:
Current Property Premium:
Equipment:*
- Yes
- No
Current Equipment Carrier:
Current Equipment Premium:
Why Are You Requesting A Quote Today?*
When Will You Be Ready To Buy?
Insurance & Loss History
Any policy been cancelled or non renewed in past 3 years?*
- Yes
- No
If yes, please explain policy type and reason:
Losses under any policy in past 3 years?*
- Yes
- No
If yes, please explain policy type, give brief description of claim, approximate date, and amount paid:
Comments:
Once you hit submit, your web form will be reviewed by an experienced contractor insurance specialist who will review your application and will be in touch if additional information is needed. In many cases, a proposal may be offered during the next business day.