Contractor Questionnaire

Name

First NameLast Name

Business Name

Estimated Revenue for the Next Year?

Estimated Payroll for the Next Year (W2 Employees Only)

Business Address/ Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Select All the Lines You Need Quotes For

How Many W2 Employees Do You Have?

What's the Reason You're Shopping?

How Soon Do You Need a Quote Back?

Detailed Description of Operations

Who Are You Currently With for Each Line of Business? (GL, WC, Auto, etc.)

How Long Have You Been With Them?

Have You Had a Claim on Any Policy in the Last 5 Years?

Please Explain the Claim(s)

What Kind of Contractor Are You?

Do you have any industry-specific certifications? (e.g., ISO, LEED)

Do You Subcontract Any Work Out?

What Safety Programs Are in Place?

What's the Maximum Height Employees or Subcontractors Work at?

What Percent of Work is Subbed Out?

What's the Cost(amount paid) for Subcontracted Work?

Do All Subcontractors Carry Liability Limits Equal or Higher than Yours?

What Kind of Roofing Do You Install? (Metal, Asphalt, Wood Shakes, etc.)

Any Torch Work?

How Do Employees and Materials Get to the Roof? (Scaffolding, Ladders, Lifts, etc.)

Any Work On the Following?

Percent of Commercial vs Residential Work?

Do You Need Coverage for Your Building?

What Types of Siding Do You Install?

Any Window Installation?

Any Roofing Work?

Do You Use Ladders, Scaffolding, or Lifts?

Do You Do Any Work On the Following?

What's the Cost of Subcontracted Work? (Dollar Amount)

Do All Subs Sign a Subcontractor Agreement?

Detailed Description of Work Performed by Subcontractors

Roof Year of the Building?

What Year was the HVAC Replaced?

What Year was the Plumbing Replaced?

What Year was the Electrical Replaced?

Do You Trim Trees?

How Do You Get Up to the Trees? Lifts, Boom Truck, etc.?

List All the VINs, Year, Make, and Models for Your Vehicles

Have you had any safety violations in the past 5 years?

If yes, please explain

I certify that the information provided in this questionnaire is accurate and complete to the best of my knowledge.

Name

First NameLast Name

Title

Signature

Date signed

Date