Contractors Form
Please fill out this form to be contacted with a quote.  You'll notice that most are not required, but the more you answer, the easier it will be for us to quote.  We try to ask as few questions as necessary.  Thanks!
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Contractor Business Name: *
Business Address: *
How did you hear about us?
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Phone number:
Entity type:  
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If not corporation:  Owners full name & home address: *
FEIN Number or Social Security # if Individual/Sole proprietor: *
Owners Date of birth: *
MM
/
DD
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YYYY
Email: *
What percent of your work is residential vs. Commercial?
0%
Less than 20%
20%
40%
60%
80%
100%
Residential work
Commercial work
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 # of New Homes/year
General Contractor?
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What percent (revenue/income) of the following do you do…. (Please try and add to 100%)
0%
less than 20%
20%
40%
60%
80%
100%
Electrical
Excavating
Concrete-flat
Interior Painting
Exterior Carpentry
Insulation
Drywall
Windows
Plumbing
Snowplowing
Siding
Roofing
Landscaping
Interior Carpentry
Concrete-wall
Heating/Cooling
Other
Pool/Spa
Exterior Painting
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Year business started: *
Please enter number
 # of Years experience in this field: *
Please enter number
Current Carrier name
# years with current carrier:
Please enter a number
Gross Annual Income:
Please enter number
  # of Emp (full & part time):
Annual Payroll (W2):  (does this amount include owner payroll?)
Owner Payroll total
Any Subcontractors used:
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Annual Subcontractor Cost:
Do you require certificates of insurance from subcontractors w/equal liability limits:
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Business Personal Property and tools coverage amount:  
Please enter $ amount
Scheduled Items and Approximate Values:
Occupancy:
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 Sq Footage Occupied:
% office space
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% warehouse/shop space
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% That has Sprinkler
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Alarm
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Any Additional comments:
Only answer Questions below if you are the building owner
Questions only necessary if you are the building owner
Building Coverage Limit (if owner):
Please only answer if you are the owner
Building construction type:
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Please tell us the Years your wiring, roofing, plumbing and heating were last updated
Year Building Built:
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This form was created inside of Shield Insurance Agency.