General Commercial Insurance Master

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Artisan Contractor Insurance Prospect Questionnaire

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Business Information

Legal Business Name:

Email:

DBA(s)

Business Address:

Mailing Address (if different)

Entity Type:

Years in Business

Years of Owner Trade Experience:

Contractor's License Number:

States of Operation:

Operate Year Round or Seasonally?

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Trade & Operations

Primary Trade

List All Services Performed

% of Work in Each Trade

Work Outside Primary Trade? (Y/N)

% Residential vs. Commercial

Type of Work (new construction/remodel/repair)

Work on Multi-Family Dwellings? (Y/N)

High-Rise or Over Two Stories? (Y/N)

Structural Changes or Load-Bearing Work?

Hazardous Work? (Y/N)

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Subcontractors & Employees

Number of Employees

Use Subcontractors? (Y/N)

% of Work Subcontracted

COIs Obtained from All Subs? (Y/N)

Additional Insured on Sub Policies? (Y/N)

Use Independent Contractors? (Y/N)

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Payroll, Sales, & Job Size

Estimated Annual Payroll

Estimated Annual Gross Receipts

Average Job Size ($)

Largest Job Size in Past 3 Years ($)

Tools, Equipment, & Property

Tools, Equipment, & Property

Value of Owned Tools/Equipment

Rent/Lease Equipment? (Y/N)

Equipment Left on Job Sites Overnight? (Y/N

Need Inland Marine (equipment) Coverage?

Store Materials at Warehouse/Yard? (Y/N)

Security Measures in Place

Safety & Risk Management

Safety & Risk Management

Formal Safety Program? (Y/N)

Employee Safety Training? (Y/N)

Use of Safety Gear (Y/N)

Work Involving Scaffolding/Lifts/Cranes? (Y/N)

Written Contracts with Clients? (Y/N)

Contracts Include Hold Harmless Clauses? (Y/N)

Vehicles

Vehicles

Company-Owned Vehicles? (Y/N)

Employee-Owned Vehicles Used for Work? (Y/N)

Need Commercial Auto Coverage? (Y/N)

Insurance History

Insurance History

Current Insurance Carrier

Policy Expiration Date

Current Liability Limits & Deductibles

Claims in Last 5 Years? (Y/N)

Details of Claims

Prior Cancellations or Non-Renewals? (Y/N)

1380 Pantheon Way #200,

San Antonio, TX 78232

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