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Contractors Insurance Quote Request Form

 Fill out the form below to obtain your Contractors Insurance quote.  The quotes provided here are for Connecticut only.   To obtain an accurate quote, please be as complete as possible.  The Red fields are required and must be filled in.

Client Information
Name:   
Company Name:
Address1:
Address2:
City/State/Zip: / /
Phone:
Fax:
Email:

 

General Contractor Information
Organization Type other:
Contractor Type:
Any operation or property that is owned, leased or occupied that is not covered by this policy?
If Yes, please describe:
Have you declared bankruptcy or had any financial problems in the past 7 years?
If Yes, please describe:
Do you perform more than 10% of your work in a state other than your state of domicile?
If Yes, please describe:
Total number of employees (Owners /
Officers / Partners):
Total number of employees (not including Owners / Officers / Partners)
Total payroll: $
Number of years experience
Percentage of work performed within 50 miles of your base of operations: %
Amount of sales receipts for current year: $
Amount of sales receipts for prior year: $
Percentage of work which is residential : %
Percentage of work which is commercial: %

 

Complete if Residential or Remodeler Contractor
Do you require to be named as an Additional Insured on the subcontractor's policy?
If No, please explain:
Do you ever act as a Construction Manager?
If Yes, annual fees: $
Description:

 

General Liability - Complete if Residential or Remodeler Contractor
Any owned autos?
Do you build/remodel condominiums or multi-family dwellings?
If Yes, please describe:
Do you build/remodel commercial buildings exceeding 10,000 square feet?
If Yes, please describe:
Number of Housing Starts: Current Year
Prior Year
Percentage of work which is New Construction: %
Percentage of work which is Remodeling: %

 

General Liability - Complete if Trade Contractor
Do you have any owned autos?
Do operations include tunneling or trenching work deeper than 3 feet?
If Yes, please describe:
Do you contact utility services prior to digging or working with overhead wires?
If No, please explain:
Do you perform dam or levee work or have you done so in the last 10 years?
If Yes, please describe:
Do you perform work at landfill sites or have you done so in the last 10 years?
If Yes, please describe:
Do you perform any railroad track / trackbed construction, repair or maintenance or have you done so in the last 10 years?
If Yes, please describe:
Do you install any automatic sprinkler or fire suppression systems or have you done so in the last 10 years?
If Yes, please describe:
Do you install fire alarms or smoke detectors or have you done so in the last 10 years?
If Yes, please describe:
Do you install or repair gas mains (excluding hose connections) or have you done so in the last 10 years?
If Yes, please describe:
Do you install, service or repair high pressure boiler systems or have you done so in the last 10 years?
If Yes, please describe:
Do you apply "Exterior Insulation Finish Systems"(a/k/a "Synthetic Stucco") or have you ever done so in the past?
If Yes, please describe:
Any remodeling involving foundation, structural changes or movement of load bearing walls?
If Yes, please describe:
Minimum General Liability limits required of subcontractors: $ Per Occurrence
$ Aggregate

 

Contractors Equipment - Complete if requesting this Coverage
Any Mobile Equipment?:       If yes, please complete below.
Does operator have less than 2 years experience in operating the equipment?  
If Yes, please comment:
Does this mobile equipment have any maintenance program in place?
If Yes, please describe:
Is equipment secured and protected when not in use?
If Yes, please describe:

 

Select the Method you would like this Quote Forwarded to you

If the address or number you want the quote sent to is different from what you specified above then specify the new one after the selected method.  We will send you a prompt reply.  Thank you for considering the Prindle Insurance Agency.

Email
Fax
Letter

 

/ /
Would you like a rep to call you?
Thank you for considering the Prindle Insurance Agency!  Be sure you have completed the required fields and have provided us a method of forwarding your Contractors Insurance Quote to you. If you have any other information you would like for us to consider or you have general questions or comments, please enter them in the box below, then click the submit button. We will respond to you promptly.
Comments / Questions
 
Thank you for considering the Prindle Insurance Agency!

The Prindle Insurance Agency is a member in good standing with:

The National Association of Independent Insurance Agents

The National Association of Professional Insurance Agents.

Prindle Insurance Agency
22 West Main Street
Sharon CT 06069
Phone: 1 860 364 5000
Toll Free Number: 1 877 422 4555
Fax: 1 860 364 5072

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