Commercial - Artisan Contractor, Auto and Service Repair, Real Estate & General Contractor
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  • Business Insurance Quote Form

  • Format: (000) 000-0000.
  • Do we have permission to communicate via text with you at this number?*
  • Owner's Date of Birth
     - -
  • Business Entity:
  • When Was Business Established*
     / /
  • Is this an established business with previous insurance?
  • Does the named insured have other commercial policies insured with Farmers?
  • Are there other businesses not insured by Farmers that are owned by the same Named Insured and not shown on this application?
  • What is the company category that you are trying to insure?

  • Artisan Contractor

  • Is the applicant or their employees a general contractor or hold a current generalcontractor license?
  • Has the applicant ever acted as a developer or plan to act as a developer in the future?
  • Are any of the employees engage in or perform any type of design orarchitectural work?
  • Does the applicant subcontract any work?
  • Are all subcontractors hired by the applicant required to provide a certificate ofinsurance?
  • Is the applicant’s work limited to renovating and remodeling on existingstructures?
  • Is the applicant holding any licenses under a different name or DBA or everoperated under a different business name or DBA?
  • Has the applicant ever acted as a developer or plan to act as a developer in the future?
  • Are any of the employees engage in or perform any type of design or architecturalwork?
  • Is the applicant engaged now or has been in the past 10 years constructing newmulti-unit residential projects with four units or more?
  • Does the applicant engage in direct importing from overseas manufacturers?
  • Do the applicants operations include snowplowing during seasonal months?
  • Does the applicant install, service, or repair equipment for hospitals, medicalcenters, medical research facilities, schools or municipalities?
  • Does the applicant provide water restoration services?
  • Does the applicant engage in the sale and/or installation of refurbished equipment or appliances?
  • Do the applicants operations include snowplowing during season months?
  • Does the applicant provide 24 hour emergency service?
  • Does any state in which the applicant operates require the applicant to hold a Contractor’s License?
  • Hard Copy of Loss Runs:
  • Losses:
  • Has the applicant had any Business Insurance Policy cancelled in the last 3 years?
  • Actual Cash Value (ACV):
  • Construction:
  • Fire Sprinkler System:
  • Sprinkler Type:
  • Fire Sprinkler System Regularly Maintained?
  • Occupied As?
  • Is more than 25% of the building occupied by others?
  • The following Liability coverage show only if both Property and GL are Selected: General Liability Aggregate / Products/Completed Operation Aggregate:
  • Premise Operation and Products Completed Operation Deductible:
  • Medical Expense (any one person):
  • Employee’s Liability (Stop Gap)* (ND, OH, WA, & WY Only)
  • Subcontracted Work?
  • Has the building undergone a comprehensive renovation since it was originally built? (Comprehensive renovation means complete gutting to the exterior walls with completely newinterior walls, plumbing, heating, wiring and roof.)
  • Renovation Date
     - -
  • Employment Practices Liability Insurance
  • Are there any vehicles leased to others?
  • Is there hazardous cargo or hauling of goods, materials, or commodities thatrequire Department of Transportation signs or lettering?
  • Are there any hold harmless agreements required?
  • Are there courtesy vehicles?
  • Does the prospect have any vehicles that require an operating radius beyond 500miles?
  • Are there Public Transportation Exposures – other than Courtesy vehicles?
  • Are there specialty uses or is there sponsoring of Special Events?
  • Are there any oversized, overweight or unstable loads?
  • Are any vehicles used for the following?
  • Is one of the following filings required: MCP, SR, ICP, or PUC?
  • Are vehicles used to remove debris for a fee?
  • Are any listed vehicles used for the public to enter and receive a service orconduct business?
  • Are any vehicles used to haul industrial or hazardous recyclables such as batteries or used oil, or do any listed vehicles or the load require a hazardous material placard, or are any vehicles ambulances, armored carriers, or garbage trucks?
  • Is this vehicle used as a living facility more than 30 days per year?
  • Are any vehicles used for garbage, waste, or trash removal?
  • Are there high-valued goods, including merchandise subject to theft?
  • Are there any vehicles that have Permanently Mounted Special Equipment?
  • Are there any vehicles that have been customized, altered, or that have Special Equipment?
  • Rows

  • Auto Service and Repair

  • Is work performed on vehicles over 20,000 pounds?
  • Is work performed on motor homes, travel trailers, and motorcycles ATV’s, ATC’s,snowmobiles, boats or off road vehicles and equipment?
  • Is work performed primarily on rental vehicles?
  • Is work performed on vehicles with specialized equipment?
  • Are there mixed occupancies (such as gasoline stations with grocery/conveniencestores, restaurants, auto parts stores, or car washes)?
  • Do any of the following types of repair account for 25% or more of total receipts:Air Bags, Suspensions, Frame Straightening / Repair / Replacement?
  • Is there any re-building or re-manufacturing of parts?
  • Are there auto dealers or auto sales?
  • Do operations include customized design and installation, modifying or eliminatingemissions controls?
  • Or high performance exhausts systems?
  • Do Operations involve customized glass installation or glass repair – building(Residential or commercial)?
  • Do operations involve customized transmissions for high performance vehicles, orrebuilding of transmissions to exceed the manufacturers’ specifications forperformance?
  • Do operations include used, retreaded or recapped tire sales and/or installation,or tire retreading?
  • Has the applicant had any Business Insurance Policy cancelled in the last 3 years?

  • Garage Liability

  • Garage Liability Limit
  • Garage Completed Operations Deductible
  • Garage Medical Payment Limit
  • Broad Form Products
  • Additional Insured - Owner of Garage Premises

  • Garage Keepers

  • Garage Keepers Coverage
  • Rating Basis:
  • Comprehensive Deductibles:
  • Construction:
  • Roof Type:
  • Fire Sprinkler System:
  • Sprinkler Type:
  • Fire Sprinkler System Regularly Maintained?
  • Franchise:?
  • Occupancy
  • When did the business start operation at this location:
     - -
  • Is the applicant the sole occupant of the building?
  • Is more than 25% of the building occupied by others?
  • Indicated the type of alarm at this location:
  • Where is the business located?

  • Additional Questions

  • Building Improvements / Renovations at this Location
  • Has the building undergone a comprehensive renovation since it was originally built? (Comprehensive renovation means complete gutting to the exterior walls with completely new interior walls, plumbing, heating, wiring and roof.)
  • Enter renovation date:
     - -
  • Are there mobile operations?
  • Are loaner vehicles provided to customers?
  • Is there a need for Dealer Tags and/or Transporter Plates?
  • Any tire sales/installation/service or repair?
  • Any towing operations?
  • Medical Payments:
  • Comp Deductible:
  • Waive UM coverage on all Vehicles?
  • In Transit (On Hook) Coverage for Towing Operations?
  • Legal Liability Direct Excess/Direct Primary
  • Hired Auto Liability
  • Hired Auto Physical Damage
  • Drive Other Car?
  • Does the insured conduct test drives of customer vehicles?
  • Are any garage operations conducted off -premises?
  • Does insured perform service or repair on any of the following types ofvehicles/equipment?  (Forklifts/Heavy equipment/ machinery/motor homes/5th wheels/hitches/suspension systems/tractors)?
  • Are written/formal procedures in place to advise customers of outstanding repair issues?
  • Any alcohol sales?
  • Hours of Operations:
  • Other policies with the Farmers Insurance Group?
  • Is the building design intended for this type of operations?
  • Are hazardous material properly stored and disposed of?

  • Auto Coverage Section

  • Are there any vehicles leased to others?
  • Are there any hold harmless agreements required?
  • Is the insured a grain hauling contract carrier?
  • Does the prospect have any vehicles that require an operating radius beyond 500miles?
  • Are there courtesy vehicles?
  • Are the vehicles used to transport passengers?
  • Are there Specialty uses or is there sponsoring of Special Events?
  • Are there any oversized, overweight or unstable loads?
  • Are any vehicles used for the following?
  • Are there high-valued goods, including merchandise subject to theft?
  • Is one of the following fi lings required: MCP, SR, ICP, or PUC?
  • Are vehicles used to remove debris for a fee?
  • Are any listed vehicles used for the public to enter and receive a service or conduct business?
  • Are any vehicles used to haul industrial or hazardous recyclables such as batteries or used oil, or do any listed vehicles or the load require a hazardous material placard, or are any vehicles ambulances, armored carriers, or garbage trucks?
  • Is this vehicle used as a living facility more than 30 days per year?
  • Are any vehicles used for garbage, waste, or trash removal?
  • Are any listed vehicles used for repossession work?
  • Rows

  • Real Estate

  • Auto Details

  • Are there any vehicles leased to others?
  • Is there hazardous cargo or hauling of goods, materials, or commodities thatrequire Department of Transportation signs or lettering?
  • Are there any hold harmless agreements required?
  • Are there Courtesy Vehicles?
  • Are there Public Transportation Exposures – other than Courtesy vehicles?
  • Are there specialty uses or is there sponsoring of Special Events?
  • Are there any oversized, overweight or unstable loads?
  • Are any vehicles used for the following:
  • Vehicles
  • Are there high-valued goods, including merchandise subject to theft?
  • Are there any vehicles that have Permanently Mounted Special Equipment?
  • Are there any vehicles that have been Customized, Altered, or that have SpecialEquipment?
  • Is one of the following filings required: MCP, SR, ICP, or PUC?
  • Are vehicles used to remove debris for a fee?
  • Are any vehicles used for garbage, waste, or trash removal?
  • Are any listed vehicles used to transport passengers to and/or from home?
  • Are any listed vehicles used to provide sightseeing tours?

  • Policy Level Underwriting

  • Is this business a franchise?
  • Is this a home based business?
  • Has the applicant had any Business Insurance Policy cancelled in the last 3 years?

  • Policy Details

  • What is the primary occupancy type?
  • Actual Cash Value:
  • Building Functional Value:
  • Construction:
  • Roof Type:
  • Fire Sprinkler System:
  • **Is the sprinkler system regularly maintained?
  • Does the owner operate a business out of this building (other than to support or maintain the building or tenants)?
  • Does the applicant require all tenants to carry property and liability insurance?
  • *Are there Daycare or Bars/Taverns at this location?
  • Did the applicant/owner obtain Certificates of Insurance from all occupants?

  • Additional Questions

  • Building Improvements/Renovations at this Location:

  • Has the building undergone a comprehensive renovation since it was originally built? (Comprehensive renovation means complete gutting to the exterior walls with completely new interior walls, plumbing, heating, wiring and roof.)
  • Enter renovation date:
     - -
  • Is a professional property management company used at this location?
  • Is the original design intended for the type of operations being conducted at this location?
  • Does any tenant conduct manufacturing operations at this location?
  • Is the applicant responsible for the parking lot?

  • Building Cost Estimator

  • Basement:

  • Auto Coverage Section

  • Rows

  • General Contractor

  • Limits of Liability Requested

  • During the past 3 years has any company ever cancelled, declined or refused to issuesimilar insurance to applicant?

  • PREVIOUS INSURER AND PRIOR LOSS INFORMATION

  • Has the insured or applicant had 3 years of prior coverage? If yes, please complete the Prior Insurer information for the past 3 years below (Year, Insurance Company, Policy # and Premium).
  • Has the insured or applicant had any prior claims or losses in the last 3 years? If yes, please complete the Loss information below (Date of Loss, Loss $ Amount Paid, Loss $ Amount Reserved and Description)
  • Type of license:
  • Do you use subcontractors?

  • If yes, please complete the following:

  • Do you collect certificates of insurance from all subcontractors?
  • Do you require all subcontractors to name you as an additional insured?
  • If yes, have you always done so in the past?
  • Have you ever performed work as a subcontractor for a general contractor?
  • Do you have a written hold harmless agreement in your favor in the contract with the subcontractors you use?
  • Rows

  • Describe your four largest projects for the past 5 years, including values:

  • Describe the four largest projects planned for the upcoming year, including values:

  • Do you or have you acted in any capacity in the construction of new buildings?
  • Have you ever been involved in the construction or remodeling of apartments, townhouses, condominiums, tract homes, or unplanned multi unit developments?
  • Do you plan to do so in the future?

  • Do you perform any of the following?

    Answer"Yes" – if the activity has or will be performed, subcontracted orsupervised by the applicant.

    Answer"No" – if the applicant has never and does not plan to perform,subcontract, or supervise the activity.

  • Asbestos or lead abatement
  • Boiler installation / repair
  • Concrete tilt-up construction
  • Dam work
  • Demolition
  • Environmental cleanup
  • Industrial machinery repair or installation (millright work)
  • LPG work
  • Medical &/or industrial life
  • Process piping
  • Blasting
  • Fire or water restoration
  • Rental of equipment to others
  • Retaining walls
  • Road / highway / bridge /  No overpass construction
  • Roofing
  • Swimming pool construction
  • Traffic signals / control work
  • Underground tank removal
  • Use of cranes
  • Work on gas lines or pumps
  • Mold remediation
  • Synthetic stucco (EIFS)
  • Are you involved in exterior painting?
  • Do you perform any concrete work involving room additions, structuralalterations or foundations?
  • Is any equipment leased from others?
  • Are you or your subcontractors involved in any removal of asbestos, PCB’s or otherhazardous materials?
  • Do you draw any plans or blueprints used in your construction work?
  • Do you now or have you ever performed work on hillsides, slopes, landfills, orother subsidence areas, or do you plan to in the future?
  • Do you perform work above 4 stories in height other than interior remodeling?
  • Do you use scaffolding?
  • Have you ever been named in litigation regarding faulty construction or constructiondefect?
  • Are there any claims or legal actions pending against any of the entities named inthe application?
  • Do any of the entities named in the application have knowledge of any pre-existingact, omission, event, condition, or damage to any person or property that maypotentially give rise to any future claim or legal action against any suchentity?
  • Are you involved in any business other than contracting?
  • With respects to CALIFORNIA and NEVADA, have you done, are you doing, or do you planto do any work in these state(s)?
  • l. Any work performed on road/bridges/highways/overpass/traffic signals?
  • m. Any structural work performed?
  • n. Any explosive materials used?
  • o. Any underground boring or directional drilling?
  • p. Any blasting operations?
  • q. Any work on railroad easements?
  • r. Any mold remediation?
  • s. Any controlled burns or burning of debris?
  • t. Any caisson work performed?

  • If YES to any of the above, please describe in Remarks section:

  • 13. PREVIOUS INSURER AND PRIOR LOSS INFORMATION.

  • Has the insured or applicant had 3 years of prior coverage?

  • If yes, please complete the Prior Insurer information for the past 3 years below (Year, Insurance Company, Policy # and Premium).

  • Has the insured or applicant had any prior claims or losses in the last 3 years?
  • 14. Any Work subcontracted?

  • If yes, PLEASE COMPLETE NEXT SECTION. If no, THE FORM IS COMPLETE.

  • ADDITIONAL INFORMATION TO BE COMPLETED ONLY IF APPLICANT USES ANY SUBCONTRACTORS

  • 18. Type of work:

  • 19. What percentage of your work is

  • 21. Do you collect certificates from all subcontractors?

  • PLEASE NOTE THAT UNDER THE ARTISAN PROGRAM ALL SUBCONTRACTORS MUST PROVIDE CERTIFICATES OF INSURANCE FOR EQUAL LIMITS

  • 22.Do you require all subcontractors to name you as an additional insured?

  • 23. Do any of the subcontractors you use perform any of the following work?

  • a. Roofing of any kind?
  • b. Mold / Asbestos removal?
  • c. Exterior Painting?
  • d. Drilling of any kind?
  • e. Spray Painting?
  • f. Welding?
  • 24. Have you ever been named in litigation regarding faulty construction defect?
  • 25. Are there any claims or legal actions pending against any of the entities namedin the application?
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