Name: Abbott Insurance, Inc
Price range: $

YOUR NAME

First

Last

What kind of quote do you need? Select all that apply

General Liability
Workers Compensation
Commercial Property
Inland Marine/Business Property

Business Name

Business Structure

Year business was started?

Is the business currently insured?

Yes
No

Reason(s) for no insurance. Check all that apply:

New Venture
No employees
No contractual need
Forgot to renew prior policy

Effective Date

Owner Name

First

Last

Phone

Email

EIN/TAX ID

Street Address

Street Address 2

City

Dropdown

ZIP

Business Address same as Mailing Address?

Yes
No

Address

Address Line 1

Address Line 2

City

State

Zip Code

General Liability

Total Annual Revenue

General Liability Limits

Types of Projects

Types of work performed

Type of work performed

Does this applicant perform any new construction?

Yes
No

Does the applicant perform only "remodeling" projects?

Yes
No

Work Comp

Are insured subcontractors used?

Yes
No

If subcontractors are used, explain the following items to the customer:

Subcontractors are required to carry limits equal to or greater than your limites
Subcontractors are required to name you as additional insureds on their policies
Subcontractors are required to provide you with a hold harmless agreement
Certificates for subcontractors must be retained for 5 years

Total Residential Subcontractor Cost

Total commercial subcontractor cost

Are uninsured subcontractors used?

Yes
No

Total Residential Subcontractor Cost

Total commercial subcontractor cost

Does the business have any employees or use any temporary laborers or 1099 employees?

Yes
No

Employee Classification

Owner Class Code

Confirm the following:

Limits of Liability

Is waiver of subrogation required?

Yes
No

Owner and Partner Information

Owner/Partner Name

First

Last

Employee Classification

Do any of the following apply?

Is any work Performed Underground Greater than 8 Feet (excluding swimming pool contractors) Applicant Engaged In Any Other Type Of Business
Is the total subcontractor exposure is greater than 50%?
Is any group transportation used?
Are employees traveling out of state?
Do you have an early return to work program?
Do you have a safety program in place?
Is any work completed over 30 ft?
Is any demolition or wrecking work completed?

Commercial Property

Is there an alarm system?

Yes
No

Coverage Form

Building Protection Class

Deductible

Occupancy Type

Eligibility Questions - check all that are true

Is the applicant currently in Bankruptcy proceedings?
Has applicant(s) been indicted or convicted of any degree of crime, fraud, bribery or arson on any property
Is the Property undergoing construction, renovations or vacant?
Is the construction year less than 1930 or year built prior to 1950 without a gut rehab in the past 25 years?
Is the Property scheduled for demolition or have existing damage?
Is the Property a Mobile, Manufactured or Modular Home?
Do any risks contain any of the following in their electrical systems: knob and tube wiring, Aluminum Wiring, Pig-tailed wiring
Are any locations on the Historical Registy?

Inland Marine

What kind of equipment do we need to insure? Check all that apply

Miscellaneous Tools valued $1,500 or less per item
Scheduled Equipment and Machinery
Rented or Leased Equipment

Miscellaneous Tools - Total Amount of Coverage Needed

Year/Make/Model/VIN/Serial of Equipment

Value of equipment

What is the rented equipment limit needed? Typical is $100k

Eligibility Questions - Check all that are true

Has the applicant incurred more than $5,000 in paid Inland Marine losses (including expenses) or had more than one (1) claim?
Is the applicant's Inland Marine loss ratio for the past four (4) years greater than 40%?
Are annual rental costs for rented equipment (if any) over $50,000?
Is the applicant involved in activities involving CRANES, ASPHALT PLANTS, BRIDGE BUILDING or DREDGING or WATER WAYS?
Is the applicant involved in activities involving EQUIPMENT RENTAL TO OTHERS WITHOUT AN OPERATOR?
Is the applicant involved in activities involving FARMING, LOGGING or MINING - SURFACE OR UNDERGROUND?
Is the applicant involved in activities involving NON-CONTRACTING ACTIVITIES, RECLAMATION OF LANDFILLS or OIL FIELDS?
Is the applicant involved in activities involving STRUCTURAL DEMOLITION or ROOFING?

Additional Information that doesn't fit above

COMMERCIAL INSURANCE

Request a Commercial Insurance Quote

General Liability

Types of Projects

Types of work performed

Work Comp

Employee Classification

Owner Class Code

Owner and Partner Information

Employee Classification

Commercial Property

Inland Marine