General Liability Insurance Quotes
Please take a moment to fill out the General Liability Questionnaire which will be assigned to a team member. Your information will be kept confidential and will only be used for quoting purposes.
Fill out the questionnaire and return it via email.
All policies are subject to audits. Underestimating Payroll, Gross Receipts or Sub Costs can result in additional premium at time of an Audit..
State / Province / Region
ZIP / Postal Code
State / Province / Region
ZIP / Postal Code
Company Website URL (www)
Residential General Contractor
Residential Specialty Contractor
Commercial General Contractor
Commercial Specialty Contractor
OR Contractor License #
WA Contractor License #
Number of Owners/Partners
Total Gross Receipts $ (Annual)
Employee Payroll $ (Annual)
Number of Employees
For purposes of this application, Employee is defined as an individual working for you (the applicant), which receives a w-2 tax form or you withhold & pay employment related taxes for that individual.
“New residential” work is defined as work being performed on newly constructed properties that are not yet certified for occupancy.
Out of 100%, New Construction vs. Remodels
What % of your work is New Construction?
What % of your work is Remodels?
Out of 100%, Residential vs. Commercial
What % of your work is Residential?
What % of your work is Commercial?
Out of 100%, Interior vs. Exterior
What % of your work is Interior?
What % of your work is Exterior?
If YOU USE SUBCONTRACTORS
Annual Sub Costs $ (Annual Projection) Include Labor & Material
Indicate the type of work you will be subcontracting:
Will you be subcontracting in the next 12 months?
Do you always collect certificates of insurance from sub-contractors?
Do you require subcontractors to have insurance limits equal to your own?
Do you always require subcontractors to name you as additional Insured?
Do you have a standard formal written contract with subcontractors?
If yes, does it have a hold harmless/indemnification agreement in your favor?
Do you require subcontractors to carry Workers Compensation?
Provide a Brief description of your business operations:
Explain the type of work you plan to do in the next 12 months
List your 3 largest projects over the past 3 years, including values:
List current projects currently underway or planned for the next year, including values:
Will your upcoming work involve any “NEW” Construction in:
Do you do work on “New” Condominiums, townhouses, apartments or tract homes over 25 units at any one time, except for repair or remodeling within a development at any given time?
Indicate max. Number of homes in the entire subdivision:
How many of these homes will you be working in at any given time?
What type of Additional Insured Endorsements are you required to produce?
Additional Insured Endorsements
Primary and Noncontributory
Ongoing Operations only
Ongoing Operations including Completed Operations
Do you anticipate needing Waivers of Subrogation in the next year
Only answer the following questions if you are performing any roofing work.
Modified Bitumen (HOT)
Modified Bitumen (COLD)
Hot Air Welding
Stand alone Roofing Operations
Do you have a formal safety program in place?
Do you have any planned work covered under a WRAP (OCIP or CCIP)?
In the past 5 years, have you or your company been the subject of any claim, or been named in Litigation or Arbritation, regarding faulty construction?
The purpose of this Questionnaire is to assist in the underwriting process. Information contained herein is speci cally relied upon in determination of insurability. The undersigned, there- fore warrants that the information contained herein is true and accurate to the best of his knowledge, information and belief. This Questionnaire and the application to which it is appended, shall be the basis of any insurance policy that may be issued and will be part of such policy.
Are you interested in having us quote any of the following coverages?
Stop Gap (Washington only)
Bonds (Performance, Payment, Bid)
Tools & Equipment (Inland Marine)
Coverage for your Shop or Office
Pollution Liability (Lead/ Mold)
Accident Insurance (AFLAC)
Signature must be of owner, executive officer or partner of the company
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July 18th, 2016
Clear Choice Insurance