Contractors General Liability

If you would like a representative of Carter and Company to contact you regarding Contractors Insurance, please fill in the form below. If you would like a quote, scroll down to the questionnaire below, fill it out in its entirety and submit to us. Either way, we will get back to you as soon as possible.

CONTRACTORS LIABILITY QUESTIONNAIRE
First Name:
Last Name:
Business Name:
Mailing Address:
Physical Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
E-Mail Address:

UNDERWRITING
Select Your Primary Classification:
Primary Classification %
Annual Payroll For Primary Classification (Excluding Owners, Officers & Partners)
Select Your Secondary Classification:
Secondary Classification %
Annual Payroll For Secondary Classification (Excluding Owners, Officers & Partners)
Please Fully Describe the Nature of Your Business
Number of Owners / Officers:
# of Employees: Use 0 If Necessary
Total Annual Gross Receipts:
Total Annual Sub Costs:
List Present Carrier(s) Put None If Applicable
Renewal / Policy Date
Years of Experience:
How many years have you operated under your current business name:
Losses-Claims in the last 5 years:	[Y] for Yes [N] for No
*If yes, date, amount paid and description of each* loss-claim**

INFORMATON ABOUT COVERAGES DESIRED
General Liability Coverage - Limits Required	$500,000 $1,000,000 Other
Excess or Umbrella Liability Limit	$1,000,000
Builders Risk (Indicate amount in box if desired)	$
Equipment Floater (Indicate amount in box if desired)	$
Building Coverage (Indicate amount in box if desired)	$
Contents Coverage (Indicate amount in box if desired)	$
Workers Compensation	Yes No
Auto Insurance Coverage	Yes No
Other Coverage Desired

Contractors General Liability

CONTRACTORS LIABILITY QUESTIONNAIRE

UNDERWRITING

INFORMATON ABOUT COVERAGES DESIRED

Send mail to info@cartercompany.com with questions or comments about this web site.