Clone of Contractor, Electrical Contractor

Business Name, DBA (Doing Business As)
Contact Person (First & Last Name)
Address

Street Address

CityState

Zip Code
E-mail
Phone Number

Area CodePhone Number
Whether you are a flooring contractor, retailer-installer, or specialty trade contractor, we tailor each insurance quote to reflect your specific operations, risk exposures, and industry requirements.
Cyber LiabilityExcess & UmbrellaGeneral LiabilityPropertyWorkers’ Compensation

Payroll Summary - Premium Basis

Rows	Annual Payroll
What is the annual payroll for Office / Clerical Staff employees?
What is the annual payroll for Floor installation employees?

Annual Sales

Rows	Coverage Amount
What are your company’s total projected gross sales for the next 12 months?

Building, Contents & Inventory

Please provide estimated replacement cost values for each type of property exposure at your business locations. These values are used to determine appropriate limits for building coverage, business personal property, and inventory.

Business Personal Property (Office Contents & Equipment)

Rows	Coverage Amount
What is the estimated replacement value of your office furniture, IT equipment, computers, and software?
What is the value of business-owned tools, calibration devices, testing equipment, or specialty solar hardware stored in the office or warehouse?

Rows	Coverage Amount
What is the total replacement value of all inventory stored in your warehouse?

Equipment & Jobsite Property

Inland Marine coverage protects tools, equipment, and materials while in transit or temporarily stored at job sites.

Mobile Equipment & Contractor Tools

Rows	Coverage Amount
What is the total estimated replacement value of all leased or financed equipment in use?
What is the total replacement value of small tools and field equipment (e.g., drills, solar testers, hand tools, battery-operated equipment)?

Contractor’s Yard Questionnaire

Please tell us about any permanent or semi-permanent yards, storage areas, or staging lots your business uses. This helps assess risk related to property, liability, and theft exposure.

Yard Location & Use

Rows	Yard Address
What is the physical address of the yard or storage site?
What types of materials or equipment are stored at this location?

Yard Location & Use

Rows	Dollar Amount
What is the replacement value of all items stored at the yard?

Risk Transfer

Please provide details about your subcontracted work. This section helps us evaluate risk transfer practices, compliance with insurance requirements, and how subcontractors are managed on your projects.

Rows	Amount Paid
Total cost paid to subcontractors annually

Town and Municipal Licensing Requirements

Select all towns or agencies where you plan to obtain a contractor license. We’ll ensure your policy includes the required Additional Insured endorsements for these jurisdictions.

Rows	License Required?
Suffolk County Department of Consumer Affairs
Nassau County Department of Consumer Affairs
New York City Department of Buildings (DOB)
New York City Department of Transportation (DOT)

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