NY Insurance for Contruction|New York Contractors Insurance

SPECIALIZING IN THE INSURANCE NEEDS
OF THE CONSTRUCTION INDUSTRY

To begin the quoting process please complete all questions as accurately as possible. Once finished, simply click the SUBMIT FORM button. We will then review your information and contact you as soon as possible.

For quotes on all other products:
please call us at 914-937-1230 or click here to email us

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 Workers Compensation Carrier:

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 sub-contractors cost next 12 months:

Annual payroll by class next 12 months:

Description:	Class Code:	Annual Payroll:

Have you had any claims on the past 5 years?: Yes No

If you answered yes, please explain:

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 including applications and/or loss information. Please click the button below to send us this questionnaire