THE FOLLOWING ARE GUIDELINES FOR THIS CONTRACTORS INSURANCE BUSINESS PROGRAM: NO NEW CONSTRUCTION FOR TRACTS OR SUBDIVISIONS OF 10 OR MORE HOMES NO NEW CONSTRUCTION  (other than remodeling for a single unit) FOR APARTMENTS, CONDOMINIUMS, TOWNHOUSES NO GENERAL CONTRACTORS IF:       1. You build more than 4 custom homes per year       2. You sub out more than 40%

Operations Description
Applicant is :	Individual   Partnership   Corporation
Description of Operations
Duty of Owner
S.S. Number or FEIN
Contractor License #
Number of Employees  (Excluding Owners & Clerical, if any)	Full Time    Part Time
Payroll of Employees  (Excluding Owners & Clerical, if any)
Annual Gross Receipts
Years of Experience
Years in Business
Number of New Homes Built per Year
Sub-contractors used?	Yes No
Type of Work (Sub-contractors)
Total Cost (Sub-contractors)
Do you get a Certificate of Insurance from Sub-contractor?	Yes No
Need Percent of Work	Inside                  Outside (must equal 100%)           Residential          Commercial  (must equal 100%) New Construction   Remodel/Repair (must equal 100%)

Contractors Insurance Liability Limits
Each Occurrence/Aggregate	$1,000,000/$2,000,000 $1,000,000/$1,000,000 $500,000/$1,000,000 $300,000/$500,000 $100,000/$300,000
Deductible	$1,000 $2,500 $5,000

Contractors Equipment and Tools (ONLY If coverage is desired)
Contractors Equipment (Minimum value $2,500 per item)	Scheduled  ($250,000 Maximum values)
Contractors Tools (Maximum value $2,500 per item)	Blanket / Unscheduled  ($25,000 Maximum Values)

Property Building and/or Contents (ONLY If coverage is desired)
Building Coverage	ACV or RCV
Contents Coverage	Deductibles
Square Footage	Year Built
If building is over 30 years old,   must have updates:	Wiring Date:  Renovation    Heating Date:  Renovation Plumbing Date:  Renovation         Roof Date:  Renovation
Percent of Property Occupied as:	Office %  Storage %        Apartments %      Other %
Building Construction:	Frame              Joisted Masonry   Masonry N/C   Fire Resistive
Is Building 100% sprinklered?	Yes No
Does Building have an alarm?	Yes No

Insurance Information
Current Insurance
Expiration Date
Premium?

Have you had any losses within the last three years?

Reporting Method
How would you like to receive your free Contractors Insurance Liability quote?	U.S.Postal Phone E-mail Fax