Contractor PDF

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Wednesday, January 8, 2025
General Information
What is the urgency of the quote?
Within 1 hour
Producer Name
Carmen
Producing Agency
Smart Insurance Agency Inc
Producer Phone
773-971-3827
Producer's E-mail
carmen@mysmartins.com
Proposed Effective Date
Thursday, January 9, 2025
Billing Method
Direct Bill - Insured
Policy Term
12 Months
Applicant Legal Name and DBA
ELECTRA PROPERTIES LLC
Type of Ownership
LLC
Years in Business
1
Office / Shop Address
7561 W MONROE ST
Office / Shop City, State, Zip
NILES IL 60714
Mailing Address (if same as location, enter "SAME")
SAME
Audit Contact Name
TUDOR DARIUS DAN
Audit Contact Phone
773-510-1061
Business Underwriting Information
Number of owners
1
Name of Owner 1
TUDOR DARIUS DAN
Years of Experience
10
Owner 1 Home Address (if same as office/shop address, enter "SAME")
SAME
Any other business
es owned or affili
ated in any way wi
th persons or enti
ties named in the
application within
the last 10 years
?
Yes
If Yes, list business name, operations and name of associated owner
Supreme Tech Services LLC-ELECTRICAL WORK & HVAC
Number of Employees / Helpers
0
Employee / Helper Annual Payroll
0
Gross Annual Sales
76000
% Residential Work
95
% Commercial Work
5
% New Construction
0
% Remodel
90
% Repair
10
Do you use Subcontractors for any part of your business?
No
Services Performed
Describe the applicant's general operations
ELECTRICAL WORKS
Select services performed
Electrical
Percentage of total operations
100
Specific Class Underwriting Questions
ELECTRICAL CONTRACTORS
Estimate the number of jobs performed annually (indicate Zero “0” if none):
Work outside of buildings (other than breaker box)0
Installation of emergency back-up equipment 0
Phone or computer equipment installation, service or repair0
Do you repair aluminum branch circuit wiring?
NO
Any services performed in a “clean room”?
NO
Any services performed in hazardous or explosive atmospheres?
NO
Applicant History
Does the applicant have insurance in place right now?
No
Any prior insurance cancelled, declined, or non renewed due to claims or ineligible operations?
No
Has the applicant operated for any period without insurance?
Yes
Losses and Claims
List and describe all losses or claims whether it was paid by the insurance company or not. Include the date of the loss or claim.
Have there been any claims against the applicants insurance in the past 5 years?
No
Coverage Information
General Liability Coverage
$1,000,000 / $2,000,000
General LIA for Rater
1000000
Damages to Premises Rented to You
$300,000
Medical Payments
$5,000
Add Contractors Tools & Equipment?
No
Add GL Enhancement Endorsement?
No
Add Cyber?
No
Add Business Personal Property?
No
Additional Insureds
There is a charge for additional insureds. If the policy requires an additional insured, they must be entered below for quoted premium to be accurate.
Add Blanket Additi
onal Insured Endor
sement?
Yes
General Underwriting Questions
Are records and/or invoices kept for each job including the description of materials and equipment used or installed?
Yes
Does the applicant work out of state?
No
Does the applicant have knowledge of any existing problem or construction defect on one or more of their jobs that may potentially give rise to any future claim or legal action against such person or entity?
No
Are there any lawsuits, arbitrations or disputes pending in which you are being assisted by a lawyer?
No
Does the applicant have more than 1 mechanics lien filed against others in past 5 years?
No
Has the applicant ever filed for bankruptcy or have any tax or credit leins within the past 5 years?
No
Final Comments & Submit
Attachments

Please attach any useful documents to this request by click the "Browse Files" button below.

Policy fee is fully earned at inception of policy. No flat cancel will be allowed after inception of policies. All policies are subject to minimum earned premiums.

Applicant / Agent warrants that above are true to the best of his/her knowledge.

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Rich_LaVan
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