Contractor - General Liability Quote

Please complete this form as accurately as possible in order to ensure the best possible estimate. If you would rather speak to a sales representative, please call us at 416-728-6806.

Contact Information
Name: * First Last
E-mail
Phone: * - (###) - ### ####
Fax - (###) - ### ####
Alternate Phone - (###) - ### ####
Website Address (if any)
Business Information
Business Name: *
Sole Proprietor /Partnership/Corporation
Mailing Address:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Business Address (If different from Mailing Address)
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Risk Details : Exterior Walls :

Reinforced Concrete /Hollow Concrete Block /Solid Brick Masonry/Brick Veneer/Glass Panel – Metal Frame/ Metal Clad – Steel Frame/ Metal/Vinyl Clad – Wood frame/Frame/Stucco/Open Wood, Corrugated Metal
Roof :

Reinforced Concrete/ Steel Deck/ Wood Joist/Corrugated Metal, Steel Trusses/ Heavy Timber
Floor

Reinforced Concrete/ Wood/ Concrete Pad
Type of Heating

Forced Air Gas/ Electrical/ Radiators
Type of Electrical System

Circuit Breakers/ Fuses
Total Area of Building (including basement)

In Sq Ft/ Sq Meters
Area Occupied by Insured
Number of Storeys (Excluding Basement):
Basement (Yes/No)

Yes / No
Which Year of Built

Even your office in your Home
If over 20 years old have updates been carried out (yes/no)

Which Year Heating updated Which Year plumbing updated Which Year Electrical updated Which Year Roof updated
Sprinklered (Yes/No) If Yes what percentage sprinklered
Distance to hydrant (in feets/meters)
Distance to Fire Hall (in Kms/in miles)
Building Type :

Detached Residencial/ Aprt Building/Enclosed Mall/Industrial Mall/ Retail Strip Plaza/High Rise if any describe clearly
Neighbouring Exposure

TO Left Hand Side : type of building/business & distance or adjoining TO Right hand Side : type of building/business & distance or adjoining To Back side : type of building/business & distance or adjoining
Years in Business:
Please provide a brief description on the nature of your business activities: *

Main work, e.g. Drywalls,Tiles, Hardwood, Installation of Kitchen Cabinets, Electrical work, Plumbing, Heating, Roofing, Cleaning, Landscaping, Installation of doors & windows, Remote control curtains, Painting, Spray Painting, Appliances repair & instal
Percentage of Residencial and commercial work

Residencial work % Commercial Work % Industrial Work % Total percentage equal to 100%
Percentage of Renovation work & New Construction
Do you do anywork on airport premises
Annual Gross Receipts (Income):

Gross Annual Revenue
Number of Active Owners:
Insurance Information
Previous insurance cancelled, declined or non-renewed in the last 3 years? Yes or No
Are you insured previously? * Yes No
If yes, please specify the name of the company and number of years insured:
Any Prior Claims:
Coverage Requested: $1 Million $2 Million $5 Million
Actual value of office contents
Actual Value of Stock
Actual Value of Electronic Euipment
Listing price of Tools and actual cash value
Annual Payroll (including owners)
No of Fulltime employess and number of parttime Employess(including owners)
Are all employee’s covered by worker’s compensation? Yes or No If no, please provide details of class of employees not covered
Do you subcontract work? Yes No
If yes, what percentage of your work is subbed, and what kind of work?
If yes, then, you are required to obtain Certificates of Insurance obtained from all sub-contractors How much limit accepting from sub contractors 1 million or 2 million
Do you have written contracts with sub-contractors? (yes or no)
Comments/Remarks:
The completion of this form is for quote purposes and does not provide any insurance coverage. We may require more information about your business to provide a quote. * I agree

Contractor - General Liability Quote

Contractor - General Liability Quote

Contact Information

Business Information

Insurance Information