Subcontractor Questionnaire

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information

First Name *

Last Name *

Company Name *

Street *

City *

State *

ZIP / Postal Code *

Primary Phone Number *

E-Mail Address *

Nature of Business

Year Business Established

Years of Experience

General Information

Number of Owners

Number of Employees

Annual Employee Payroll

Annual Cost of Subcontractors

Percentage of work subcontacted out

Gross Annual Sales

Do you have written contracts with your subs?

Do you require all subs to carry Workers Comp?

Do you require subcontractors to carry General Liability insurance?

What percentage of your work is residential?

What percentage of your work is Commercial?

Current General Liability Insurer:

Current Workers Compensation Insurer

Do you have any company vehicles?

Do you have any tools or equipment you wish to cover?

Please indicate coverages you are interested in

Workers Compensation
General Liability
Commercial Auto
Bonds
Owned Tools/Equipment
Leased/Rented Tools/Equipment
Builders Risk
Office contents
Other property

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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