Artisan/General Contractor Application - General Liability
is one of the largest agencies in the Western States that focus exclusively on the needs of the Western States Building Trade Contractor.
1. General Information
Contractor License Number:
Insured/Contact *
Company Name *
Phone *
E-mail Address *
Policy Term Requested

Street Address
Street Address
2. Payroll excluding Owners, Officers & Clerical
Job Class   Expected annual Payroll   Hourly Wage

Gross receipts for the next 12 months and last 12 months
Next 12 months $ Last 12 months $
3. Describe your operations

Number of owners, offices, and partners active at job sites or performing supervisory duties

4. Do you have or have you had insurance coverage?

If yes, complete the following:

A) Carrier Name and Policy Number:

B) Expiration Date:

C) How many years prior insurance coverage have you had?

5. What limits of coverage do you want?
$300,000 is minimum, but $1,000,000 is often the standard requirement
6. Do you need any special coverages, requirements, company rating, or wording?
If yes, please describe:
7. How many years of experience do you have?
In the contracting business:
In business of entities seeking coverage:
8. What percentage of your work is: (each line must add to 100%)
a. Residential
b. New Construction
  Structural remodel/additions
  Non-structural remodel
9. What percentage of your work is as a:
General Contractor
Construction Manager
10. Do you use subcontractors?
If yes, complete the following:
a. % of your work subcontracted out
Annual Costs
b. List the trades of the subcontractors you use and
give the percentage of your work they perform:
1. %
2. %
3. %
11. States in which you operate:
If not on the list, enter here
12. Describe your two largest projects currently underway or planned for the next year, including values:
13. Describe your two largest projects over the past five years, including values:
14. Dollar value of average job completed
Including all materials, labor & equipment:

a. How many new homes will you build as a general contractor in the next year?

b. What is the greatest number of new homes you have built in any one year?

16. The following question applies to work done in any capacity, including general contractor, developer, artisan, remodeling contractor, site work contractor, supplier, etc.
Have you or will you perform work involving, related to, or about the premise of:
a. Condominiums or townhouses?
Yes No
b. Apartments?
Yes No
c. Tracts, PUD's, or any other development, premises or project with more than 7 homes built or planned?
Yes No
d. Is this new construction from the groundup?
Yes No
If yes, describe in detail
Have or will any of your projects involve caissons, cantilevers, piers, retaining walls, shoring, underpinning, or other heavy structural engineering techniques?
Yes No
If retaining walls have been or will be built, maximum height: ft.
Have you or will you build, remove, repair or replace roofs?
Yes No
Hot tar: % Torch: % Total: %
Have you or will you work as a construction manager for a fee?
Yes No
20. The following questions apply regardless of whether you were at fault for a claim or incident, and regardless of whether the claim or incident was covered by insurance. Explain any "yes" answers below:
a. Have there been any losses, claims or suits against you in the past 5 years?
Yes No
If yes, provide details and obtain loss runs from prior agent for five years prior

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License # 0D80851