Contractor - General Liability Insurance 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:
E-mail
Phone:
Fax :
Alternate Phone (if any)
Website Address (if any)
Business Information
Business Name:
How long has Applicant been in business under present name?
If applicant has operated previously under another name, provide details
How many years of experience in the type of operations undertaken do the Applicant and key employees have ?
Sole Proprietor /Partnership/Corporation
General Contractor / Sub Contractor / Independent
If Partnership, Partner's name and phone number
Mailing Address: Mailing Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Business Address (If different from Mailing Address) Business Address (If different from Mailing Address)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Office Building---Landlord name and address :

Even operating your business
from Home/commercial unit
Risk details information must complete
Risk Details : Office/Home office
Exterior Walls :
Roof
Floor
Type of Heating
Type of Electrical System
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 25 years old have updates been carried out (yes/no)
If yes-provide year
Which Year Heating updated, plumbing updated,
Electrical updated. Roof updated

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
Number of years operating business at current location
Name and address of prior Employer,
and dates employed with prior employer-work performed

please provide if business is new or less than three years old
Explain any prior experience in similar 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
Breakdown of operations or construction trade and
Estimated gross receipts for coming year including cost of material, labour and sublet work for each construction trade

for example
Drywall $15,000
Flooring $20,000
Installation of Kitchen Cabinets $45,000
Roofing Shingles $20,000
Decks $20,000
Landscaping $24,000
Fence $25,000
Framing $10,000
Plumbing $5,000
Heating $10,000
and so on
Percentage of Residencial and commercial and Industrial 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
Do you do anywork outside Canada

Do you do anywork outside Canada yes no
Do you do any work carried out any oil or natural gas production, exploration or processing facility? If yes give details
Does the Applicant, handle or use or perform operations involving any of the following?
If any of the above yes, provide full details
Annual Gross Receipts (Income):

Gross Annual Business Revenue-All Receipts
includes labour,costs of material and subcontracted work also
Insurance Information
Are you insured previously?

Are you insured previously? Yes No
If yes, the name of the current insurance company, policy number and expiring premium:
Renewal Date
Number of years continuously insured?
Previous insurance cancelled, declined or non-renewed in the last 3 years? Yes or No
Are you a member of any Associations/Trade Union?

Are you a member of any Associations/Trade Union? Yes No
If yes, which Association/Trade Union?
Coverage Requested:

Comprehensive General Liability â€“ To protect yourself financially against costly claims and lawsuits
Completed Operations â€“ Provides coverage, with certain exclusions, for bodily injury and property damage claims resulting after a construction or proj
Is there any crime coverage required i.e theft of money and securities $
Installation Floater Coverage Limit $
Any Prior Claims: (yes or No) If yes-provide details

Give details of all claims brought against the applicant during the past five (5) years

I
Building $

If coverage required
Stock $
Listing price of office contents and actual value of office contents
Listing price of Electronic Equipment and actual Value of Electronic Equipment
Listing price of Tools and actual cash value
Is there any individual tool has listing price more than $1000, Yes/No
If yes provide name of tool , serial number and listing price
Annual Payroll (including owners)
# of Fulltime employees(including owners)
# of parttime employees(including owners)
Are all employeeâ€™s covered by workerâ€™s compensation?
Yes or No
If no, please provide details of class of employees not covered
Do you subcontract work?

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)
If yes-Do these agreements contain a "Hold-Harmless" provision in the applicant's favour
Comments/Remarks:
The completion of this form is for quote purpose and does not provide any insurance coverage. We may require more information in order to provide a quote. This quote request contains some information about coverage offered but it does not contain all.

The completion of this form is for quote purpose and does not provide any insurance coverage. We may require more information in order to provide a quote. This quote request contains some information about coverage offered but it does not contain all. I agree

Contractor - General Liability Insurance Quote

Contractor - General Liability Insurance Quote

Contact Information

Business Information

Insurance Information