Artisan Contractors Online Quote - Commonwealth Underwriters, Ltd.

Artisan Contractors Online Quote

Agency Name:
Agent Name:
	first and last name
Phone:
	999-999-9999 format
Fax:
	999-999-9999 format
Agent Email:	(A copy of the quote will be sent to this address)
Insured Name:
Insured State:
Would you like a finance quote?	(Click if Yes) Financing is not available for a three or six month term
What type of bonus would you like?
Would you like a finance quote?	(Click if Yes) Financing is not available for a three or six month term
Insured Zip
Insured's Mailing Address
Insured City
Insured Zip
Agency Address
Agency City
Agency State
Agency Zip Code

Application Information:
Term:
Number of Owners/Partners:
Employee Payroll (in dollars, no owner payroll) [include 1099 payroll and uninsured subcontractors]:	Please do not input commas or owner payroll. If there is no additional payroll, input zero (0).
Total Receipts (in dollars):	Please do not input commas.
Years in Business:
Years of Experience:
Limit Required:
Has the Insured had 2 or more losses or any one loss over $2,500 in the past 3 years?	(Click if Yes)
Describe any Losses:
Is Insured a New Venture?	(Click if Yes)
Has Insured had Prior Coverage?	(Click if Yes)
Has Insured had a Lapse in Coverage?	(Click if Yes)

Work Class Remove Class
I/S/R=Installation/Service/Repair I/I/A/R=Installation/Inspection/Adjustment/Repair B/S=Buildings or Structures IO=Interior Only	Inst=Installation Const=Construction (B)=Businesses Only (R)=Residential/Domestic Only
If questions appear below, check all that apply

Type of work done by you and your employees:
What percentage of your work falls under this class?	%

Add Another Class

Work Classes Cont.
Is Contractor Doing 100% Commercial Work?	(Click if Yes)
Any Residential New Construction?	(Click if Yes)
Percentage of Work that is Residential New Construction:	%
Any Roofing Work?	(Click if Yes)
Percentage of Roofing Work that is New Roofs:	%
Do you work on Tract Homes or Multiple Unit Residential Structures?	(Click if Yes)
Any Additional Insureds Needed?	(Click if Yes)
What type of Additional Insureds are Needed?
How many Additional Insureds are Needed?

Complete For Subcontracted Work
Do you hire other contractors to work for you?	(Click if yes)
Work subcontractors are hired to do:
Total subcontractor Payroll/Cost (in dollars):	Please do not input commas.
Are certificates of insurance obtained prior to subcontractors starting work?	(Click if Yes)
Minimum Limits Required:
Are you named as an additional insured on the subcontractor's policy?	(Click if Yes)
Do subcontractors carry Worker's Compensation?	(Click if Yes)

Scheduled Equipment
Does contractor have equipment to schedule?	(Click if yes)
	* Maximum value single item - $25,000 - Maximum total value - $50,000

Miscellaneous Tools
Would contractor like Miscellaneous Tools Coverage?	(Click if yes)
Total value of Miscellaneous Tools	Please do not input commas.
	* Maximum limit available online - $10,000

Any Additional Comments:

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Contact Commonwealth Underwriters

Phone: 800-396-6226

Last modified 2008-01-31

Scheduled Equipment Details Remove Equipment
Year
Model
Serial Number
Value	Please do not input commas.