Carter & Company, L.L.P. 

 

 

 

  (If not in Texas, please click here to view a list of states in which we currently have non-resident licenses.  If your state is not listed then we would not currently have a market for you.)

Builder/Contractor General Liability
General Liability Insurance Quote
For the fastest and most accurate insurance quote, please provide as much information possible in the form below. This information will be kept confidential and will be used for quote purposes ONLY!

General Information
Name of Business:
Inspection Contact Name:
Mailing Address:
City: State:   Zip:
Location Address:
City: State:   Zip:
Business Phone:   Fax:
Contact Email Address:
*Social Security # or *FEIN: *Required for quote by insurance companies
Business Status:     Years in Business:

Current Insurance Information
Carrier Name:     Premium: $
Effective Date:   Expiration Date:

Please List Any Other Previous Carriers Over the Past 3 Years Below:
Carrier Name:     Premium: $
Carrier Name:     Premium: $

Builder or Artisan Contractor:
Are you a Builder? 

Are you a General Contractor? 

Are you an Artisan (Specialty Contractor)? 		   Yes   No
  Yes   No
  Yes   No

Project/Work Information

  Please write a Description of Operations below:
 

What percentage of your work is: 
(each line must total 100%) 

Commercial % Industrial % Residential %

New Construction %   Remodel/Additions %

What percentage of your work is as a: 

General Contractor: %   Subcontractor: %

What percentage of your work is subcontracted out to:

Insured Subcontracters: %   Sub Costs: $

Uninsured Subcontracters: %   Sub Costs: $

Do you collect certificates of insurance at a $1,000,000 limit?:

  Yes     No

Receipts / Payroll / Dollar Value Info

Gross receipts for the past 3 years: 
and the next 12 months: 

(3rd yr prior) $     (2nd yr prior) $
(Last 12 mths) $  (Next 12 mths) $

Number of owners/officers/partners active at the job site or supervising: 

    

Payroll of employees excluding owners, officers, partners & clerical: 

   $

Dollar value of average job completed incl. all materials, labor & equipment: 

   $
Describe any project(s) underway or planned for the next year, including values below:

Miscellaneous and Legal Info

Have you ever performed ground up construction involving condominiums, townhouses, apartments, or single family tract developments of two (2) or more?: 

  Yes   No

Have you ever been named in litigation regarding faulty construction?: 

  Yes   No

Are there any claims or legal actions pending?: 

  Yes   No

Do any of the entities named in the application have knowledge of any pre-existing act, omission, event, condition or damages to any person or property that may potentially give rise to any future claim or legal action against any such entity?: 

  Yes   No

Coverages Desired
General Aggregate Limit of Liability Desired:

 

Each Occurrence Limit of Liability Desired:

Claims History
Enter all claims or occurrences that may give rise to claims for the prior 3 years.
This information is kept strictly confidential

Claim #1

   Claim Status: Closed   Open
Date of Occurrence:   Date of Claim:
Type/Description of Occurrence or Claim:
Amount paid on your behalf: $   Amount reserved on behalf: $

Claim #2

   Claim Status: Closed   Open
Date of Occurrence:   Date of Claim:
Type/Description of Occurrence or Claim:
Amount paid on your behalf: $   Amount reserved on behalf: $

Additional Comments

Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough space, please enter them here.


Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

   

 

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