Contractors’ Quote

About you

1. Name of Proposer/Company*

2. Your email*

3. Your phone number*

4. Years' experience.*:

Coverage Required

5. Would you like this policy to cover one specific contract?

Yes/No, if not please skip to question 12.*

6. What is the address of the property?:

7. What is the value of contract works to be insured?:

8. What is the construction period?:

9. What is being constructed?:

10. When is construction likely to begin?:

11. What is the construction material of the roof and walls?:

12. What is your estimated total annual contract value?:

13. Would you like Public Liability? If yes, what limit would you like? ($250,000/ $500,000/ 1,000,000)*.

14. Would you like Employers Liability? If yes, please list No. of workers and Annual wage roll*.

Insurance History

15. Any current insurance? If yes, with which carrier

16. Any losses or claims in the past 5 years?*