"Upholding Your Future"

1445 Main Street, Tewksbury MA 01876
tel. (978) 851-0400, (888) 466-AUTO, fax (978) 851-7270, email
atlasinsure@aol.com

Business Contractors Quote

Fill out the form below to obtain a customized Business Contractors quote. All red fields are required. Be careful to include this information before submitting your form.

Applicant Information
Company Name:
Your Name:
Street Address:
City/State/Zip: / /
Home Phone:
Work Phone:
Email:
General Information
Organization Type: other:
Contractor Type:
Trade Type (If Trade Contractor):
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 Owners/
Officers/Partners:
Total number of employees(not including
Owners/Officers/Partners) :
Total Payroll of
Employees ONLY:
$
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:

Thank You!
You've completed the form. Be sure you've included your name and company name and email address. If you have any general questions or comments, please enter them in the box below, then click the submit button. Thank you for considering Atlas Insurance. We will respond to you promptly.

General Questions/Comments:

   




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