Contractor Insurance for Colorado
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General Liability Insurance - Information Request Form
Company Info
Why so much information?
Contact Name
*Company Name Required
Address
*Address Required
Company Name
*Company Name
City
*City Reqiored
Company Type
Sole Proprietor
Partnership
Corporation
LLC
Other
Zip Code
*Zip Code Required
# of Owners, Members, or Officers
Email
*Email Required
*Must be valid email addr.
Phone
*Phone Number Required
Underwriting Info
Are you licensed?
Yes
No
License Type
License #
EIN#
Currently Insured?
Yes
No
Provide Detailed Description of your Contracting Operations
Name of Carrier
How Long Insured?
Claims in the past 3 years - Please provide details and dates
Years in Business
Years Experience in Field
Percentage of Work Residential
Number of Employees
Percentage of Work Commercial
Annual Employee Payroll
Annual Gross Sales
Do you Subcontract Work?
Yes
No
Do you work on Condos or Town Homes?
Yes
No
If you Subcontract, Percentage Subbed?
Do you have a formal written Safety Program?
Yes
No
