NY Insurance for Contruction|New York Contractors Insurance

SPECIALIZING IN THE INSURANCE NEEDS
OF THE CONSTRUCTION INDUSTRY

Please complete all questions as accurately as possible. Once finished, simply click the SUBMIT NOW button. We will then review your information and contact you as soon as possible.

Insured Name and Address

Insured

Street Address

Address (cont.)

City

State

Zip Code

County

Contact information

Contact Name

Contact Phone

Contact FAX

Contact E-mail

The year this business was started:

Current Liability Insurance Carrier:

If you currently have no coverage in force, please explain:

Current Premium:

Policy Expiration:

(dd/mm/yy)

Date for new Coverage:

(dd/mm/yy)

Describe scope of your business: (type of work performed)

Annual gross sales for the next 12 months:

Annual payroll for the next 12 months:

Annual sub-contractors cost for the next 12 months:

List the type of work that you subcontract out:

What is your average job value?:

Do you require all of your subs to provide you with
certificates of insurance naming you as additional insured:
Yes No We do not use any subs

Do you require all of your subs to sign a Hold Harmless Agreement in your favor:
Yes No We do not use any subs

What percentage of your work is:

Commercial

Residential

What % of your work is performed in the 5 boroughs of NYC

Do you perform exterior work above grade: Yes No

If yes, what is the maximum number of stories:

Do you do work below grade: Yes No

If yes, maximum number of feet below grade:

Fill in the % of work for each class of business below that your employees perform (not your subs, only your employees).

If you are a Paper GC and have no field employees, check here and go to the next section.

	%		%		%
Asbestos Removal		Grading		Plumbing
Blasting		HVAC		Roofing
Carpentry		Landscaping		Sewer
Concrete		Maintenance		Steel (structural)
Demolition		Masonry		Steel (ornamental)
Drywall /sheetrock		Mechanical		Street / Road
Electrical		Painting		Water / Gas Mains
Excavating		Paving		Other1:
Fire Suppression		Plastering		Other2:

Fill in the % of work (based on your total sub cost) for each class of business below that is performed by your subcontractors

If you do not use any subs at all check here and go on to the next section.

	%		%		%
Asbestos Removal		Grading		Plumbing
Blasting		HVAC		Roofing
Carpentry		Landscaping		Sewer
Concrete		Maintenance		Steel (structural)
Demolition		Masonry		Steel (ornamental)
Drywall /sheetrock		Mechanical		Street / Road
Electrical		Painting		Water / Gas Mains
Excavating		Paving		Other1:
Fire Suppression		Plastering		Other2:

Have you had any General Liability Claims in the past 5 years: Yes No

If yes, please describe (date of loss and description of claim):

General Comments:

Thank you for completing this questionnaire. We will review your information as quickly as possible and get back to you shortly. Depending on your business, we may or may not need additional information, applications and/or loss information. Please click the button below to send us this questionnaire.