Contractor Insurance Application | PrimeRisk Insurance

What coverage do you need?

Pick the lines you want quoted and tell us your trade. The rest of this application builds itself around your answers — you'll only be asked questions that apply to you.

Your Primary Trade The work that makes up most of your revenue

This drives the class code suggestions later on, so you don't have to know code numbers. Pick the closest match — you can add other trades below and search freely later.

Additional Trades Check any other work you self-perform

Most contractors do more than one thing. Checking these widens the class codes we suggest — it does not commit you to anything.

Tell us about your business

Start with your company's legal identity. We'll match this to your Secretary of State filing.

Company Name

Legal Business Name *

DBA (Doing Business As) if different

Addresses

Mailing address is where you receive policy correspondence. Physical address is where the business actually operates from. They're often the same — check the box if they are.

Mailing Address

Street *

City *

State *

ZIP *

Physical address is the same as mailing address

Physical Address

Street *

City *

State *

ZIP *

County

Business Phone

Business Phone *

Points of Contact

List the people we should contact for general policy questions, audits, and inspections. If one person handles all three, check “same as primary contact” and we'll copy them across.

Primary Policy Contact General questions, COIs, renewals

Name *

Email *

Phone *

Audit Contact Year-end payroll & sales audits

Same as primary contact

Name *

Email *

Phone *

Inspection Contact Carrier-ordered loss-control inspections

Same as primary contact

Name *

Email *

Phone *

Tax ID

FEIN (Federal Employer Identification Number) *

Contractor License

Do you carry a contractor's license? SUPP · Applicant Info

Yes No

Business structure & operations

Entity type, formation date, NAICS, and a detailed description of what your company actually does.

Entity Structure

Formation & Identifiers

Formation Date *

Years of Experience *

Website

NAICS Code if known

SIC Code if known

GL Class Code if known

Description of Operations

Describe what your company does * Be specific — avoid generic terms like "remodeling" or "general contractor"

# Full-Time Staff *

# Part-Time Staff *

Related Entities & Ownership

Is the applicant a subsidiary of another entity? 125 · GI Q1a

Yes No

If yes, parent company name, relationship, % owned (optional)

Does the applicant have any subsidiaries? 125 · GI Q1b

Yes No

Subsidiary name(s), relationship, % owned (optional)

Does the applicant have other business ventures for which coverage is not requested? 125 · GI Q13

Yes No

Describe the other ventures (optional)

Other Named Insureds Additional entities to be named on the policy

Premises details

Carriers want to know what each business location looks like — square footage, employees, revenue. We pre-loaded your physical address from Step 1; just fill in the rest.

Primary Location From Step 1

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Annual Revenue at this Location *

Occupied Area (sq ft) *

Total Building Area (sq ft)

Open-to-Public Area (sq ft)

# Full-Time Employees at Location

# Part-Time Employees at Location

Owner or Tenant?

Owner Tenant

Inside or outside city limits?

Inside Outside

Any area leased to others?

Yes No

Description of operations at this location

Additional Locations

Add any other office, yard, or storage location your business operates from.

Coverage requested

If you don't know what limits you want, leave them blank — your PrimeRisk agent will recommend defaults.

Policy Information

Proposed Effective Date *

Proposed Expiration Date

Lines of Business Requested (set in Step 1 — go back to change)

General Liability Form

Coverage trigger Set by the standard limits package below

Occurrence (standard) Claims-Made Owner's & Contractor's Protective

Desired Limits

Most contractors take the standard package. Pick it and move on — or choose your own limits if a contract requires something specific.

Standard — $1M / $2MRecommended The limits most contractors carry and most contracts ask for. Occurrence form, limits applying per policy. Other — I need different limits Choose this if a GC, owner, or lender requires specific limits, or you want higher ones. You'll enter each figure yourself.

Each Occurrence	$1,000,000
General Aggregate	$2,000,000
Products & Completed Operations Aggregate	$2,000,000
Personal & Advertising Injury	$1,000,000
Damage to Rented Premises (each occurrence)	$100,000
Medical Expense (any one person)	$5,000
Coverage Trigger	Occurrence
Limit Applies Per	Policy

Not sure whether this is enough? Your PrimeRisk agent will flag it if your contracts or exposure call for more — picking the standard package here doesn't lock anything in.

Employee Benefits Liability Optional add-on

This covers you if someone on your team makes an administrative mistake with your employee benefits — forgetting to enroll a new hire in the health plan, giving someone wrong information about their coverage, or missing a COBRA notice. If that employee has a claim denied as a result, they can come after the company for it, and a standard GL policy won't respond. It's usually inexpensive to add. If you have any benefits at all and one person handles the paperwork, it's worth a look.

Add Employee Benefits Liability coverage?

Yes No

Operations breakdown

Underwriters need to see how your work splits across commercial vs residential, new construction vs remodel, and what kinds of projects you take on.

Sales Mix

Retail Store / Service Operations % of Total Sales

Installation / Service / Repair Work %

Off-Premises Install / Service / Repair %

Percentage of Operations by Field Rows must sum to 100% across the four columns

	Commercial %	Residential %	Industrial %	Other %
New Construction
Remodeling / Repair
Other

Describe "Other" if applicable

New Homes Mix % of total — excludes wrap projects

1–10 Lot Subdivisions %

11–50 Lot Subdivisions %

51+ Lot Subdivisions %

Detached Custom Homes %

Apartments %

Senior / Retirement / Assisted Living %

Student Housing %

Condo / Townhome Mix % of total — excludes wrap projects

# of Units per Building

Max # of Units per Single Site

Condo Work for HOA %

Condo Repair Work for Unit Owner %

Townhome Repair for HOA %

Townhome Repair for Unit Owner %

New Condo Construction / Conversion %

Geography

In what states are your operations occurring? * e.g. AZ, NV, NM

General liability specifics

These come straight from ACORD 126. Each "Yes" opens an optional explain box — the more detail you give, the smoother underwriting goes.

General business background

A handful of underwriting questions from ACORD 125 that aren't already covered.

Safety Program

Is a formal safety program in operation? 125 · GI Q2

Yes No

Components of your program (check all that apply)

Safety manual Dedicated safety position Monthly safety meetings OSHA training

Project history

Underwriters want to see the type and size of your six largest completed jobs (past six years) and six largest upcoming projects. Best estimates are fine.

Six Largest Jobs Completed * past 6 years · SUPP · Historical Projects

Underwriters read this section closely — it is how they judge whether the work you are asking them to insure matches the work you actually do. Every box is required. If you have fewer than six jobs, or you do not have a figure handy, put N/A — that is a real answer and it will not hurt your submission. A rough number beats a blank box.

#	Project Name	Project Type (Residential, Commercial, New, Remodel, Industrial, etc.)	Gross Sales Receipts
1
2
3
4
5
6

Six Largest Projects in the Coming Year * SUPP · Current/Future Projects

What is on the books or that you are bidding. This tells an underwriter where your exposure is heading, which matters more to them than where it has been. Every box is required — use N/A for anything you do not know yet, including jobs you have not won. Estimates are fine; nobody holds you to them.

#	Project Name	Project Type (Residential, Commercial, New, Remodel, Industrial, etc.)	Gross Sales Receipts
1
2
3
4
5
6

Rating information & payroll

Five years of gross sales, projects, payroll, and subcontractor cost — then a breakdown of payroll by trade classification. Use best estimates if exact figures aren't handy.

Rating Information excludes work covered under a WRAP project · SUPP · Rating Info

	Gross Sales Receipts	# Projects / Homes Started	Total Employee Payroll (field labor only)	Subcontractor Cost (labor + materials)
Next 12 months / Renewal
Current Year
1st Prior Year
2nd Prior Year
3rd Prior Year
4th Prior Year

GL Classifications Suggestions — agent verifies

Add a row for each kind of work you self-perform. Type what the work actually is — "roofing," "dirt work," "hanging rock" — and pick from the suggestions. You do not need to know code numbers.

These are starting points, not final classifications. Your PrimeRisk agent verifies every code against the carrier's manual before quoting. Where we're not confident enough in a code number to print one, the row will say agent to assign — that's deliberate, and it costs you nothing.

Employee Payroll Breakout by Trade SUPP · Employee Payroll Breakout

Enter the annual employee payroll for each operation that applies. Leave blank if not applicable.

Operation	Employee Payroll	Operation	Employee Payroll
Architectural Work		Insulation
Carpentry (structural)		Janitorial
Carpentry (interior trim)		Landscaping
Carpentry (commercial)		Masonry (EIFS?)
Concrete Construction Flat Work		Metal Erections (dwelling)
Concrete Construction Foundations		Metal Erections (nonstructural)
Debris Removal		Metal Stud Construction
Demolition		Painting (Exterior)
Driveway Paving / Sidewalk		Painting (Interior)
Drywall		Plastering / Stucco (EIFS?)
Electrical		Plumbing
Engineering		Refrigeration
Excavation		Roofing
Executive Supervisor		Sheet Metal (outside)
Fence Erection		Swimming Pools (above ground)
Flooring (carpet)		Swimming Pools (below ground)
General Labor		Tile / Stone / Terrazzo (interior)
Grading of Land		Welding & Welding Helpers
HVAC		Other (describe in box):

Subcontractor management & risk transfer

How you manage subs is one of the biggest factors in your GL rating. Carriers reward strong risk-transfer practices.

Subcontractor Usage

Do you use subcontractors to perform work on your behalf? SUPP · Risk Mgmt Q1

Yes No

Type of work subcontracted (also captured in Step 6)

Do you use uninsured subcontractors? SUPP · Risk Mgmt Q2

Yes No

If yes, what % of subs are uninsured?

Do you use Subcontractor Agreements with all your subcontractors? SUPP · Risk Mgmt Q3

Yes No

Explain — what kind of agreement, how enforced

Quality control & job site safety

Job-site safety controls and how you handle complaints — important for both rating and loss prevention.

Coverage history & background

Existing coverages and prior claims history. We already covered the 5-year prior carrier table on Step 9, so this step focuses on the questions specific to the supplemental.

Current Coverage

Do you carry any type of Professional Liability coverage? SUPP · Cov Q1

Yes No

Type, limits, carrier

Do you carry Workers' Compensation coverage? SUPP · Cov Q2

Yes No

Carrier & policy details

Is there any model home exposure for liability coverage only? SUPP · Cov Q3

Yes No

How many model homes and addresses (required for binding)

Coverage Continuity

Have you had any lapse in coverage? SUPP · Cov Q6

Yes No

How long?

Have you operated as a developer, general contractor, or remodeler under any other name during the last 10 years? SUPP · Cov Q7

Yes No

List entity names, dates of operation

Have you performed any work without insurance within the last 8 years under the current entity? SUPP · Cov Q8

Yes No

Explain

Have you had prior coverage with a risk retention group? SUPP · Cov Q9

Yes No

Which RRG, when

Claims & Defects

Have you had any losses at all (insured or uninsured)? SUPP · Cov Q10

Yes No

Brief summary — full loss runs will be requested separately

Have you had any construction defect claim (open or closed)? SUPP · Cov Q11

Yes No

Describe

Has any principal, owner, or officer been convicted of a felony? SUPP · Cov Q13

Yes No

Provide details

Developer Status

Does your business operate as a developer (building on land you own/develop for sale)?

Yes No

Developers supplemental

These questions apply only because you indicated your business operates as a developer.

Commercial auto

Every vehicle and every driver, so we can rate this without a follow-up email. If you keep a fleet list or driver roster, have it handy — this goes fast.

Coverage Requested

Liability Limit 127 · Limits

If split limits or other, specify

Comprehensive Deductible

Collision Deductible

Uninsured / Underinsured Motorist

Additional coverages requested (check all that apply)

Hired Auto Liability Non-Owned Auto Liability Hired Auto Physical Damage Rental Reimbursement Towing & Labor Drive Other Car (owners/officers)

Vehicle Schedule Every owned, leased, or financed vehicle and trailer

Driver Schedule Everyone who drives a company vehicle

Has any listed driver had an at-fault accident, DUI, or license suspension in the last 5 years?

Yes No

Who, what, and when

Auto Loss History Last 3 years, all auto claims

No auto losses in the last 3 years

#	Date	Vehicle / driver	Description	Paid	Reserved	Open?
1
2
3

Workers' compensation

Comp is rated on payroll by class code by state. You don't need to know code numbers — describe the work and we'll suggest the code.

About the class codes below. The codes this form suggests are a starting point based on how you describe the work. Final classification is made by your PrimeRisk agent and the carrier — a suggested code here does not set your rate and does not bind coverage. If nothing matches, describe the work in plain English and we'll classify it for you.

Employer Information

States Where You Have Employees *

Total Employees *

Desired Effective Date

Experience Modification (if any)

Mod Effective Date

NCCI Risk ID / Bureau ID

Do you have any employees who travel to or work in a state not listed above?

Yes No

Which states, and how often? (this drives the Other States endorsement)

Payroll by Class Code Suggestions — agent verifies

Add a row for each kind of work your employees do. Type what they actually do — "hanging drywall," "dirt work," "office" — and pick from the suggestions.

Total Annual Payroll (all rows) calculated for you

Owners, Officers & Partners Include or exclude — this materially changes premium

Subcontractors & Uninsured Exposure

Annual Cost of Subcontracted Labor

Of that, cost paid to subs WITHOUT their own comp

Do you collect a certificate of insurance from every subcontractor before they start work?

Yes No

Explain (uninsured subs are typically added to your payroll at audit)

Do you use any leased employees, PEO arrangements, or temp labor?

Yes No

Which company, and how many workers?

Comp Loss History Last 3 policy years — carriers will pull loss runs regardless

No comp claims in the last 3 years

#	Policy year	Carrier	Policy #	# claims	Paid	Reserved
1
2
3

Property & building coverage

One block per building you own or lease — shop, office, yard, warehouse. Underwriters price this off construction, protection, and age, so the detail here directly moves your premium.

Buildings & Contents

Business Income & Extra Expense

Business Income Limit

Period of Indemnity

Extra Expense Limit

How long would it take to resume full operations after a total loss?

Deductibles & Endorsements

All Other Perils Deductible

Wind / Hail Deductible

Causes of Loss Form

Endorsements requested (check all that apply)

Ordinance or Law Equipment Breakdown Spoilage Outdoor Signs Increased Debris Removal Utility Services Interruption

Do you want flood or earthquake quoted? (both are excluded on a standard property policy)

Yes No

Which, and for which locations?

Mortgagees & Loss Payees

Name, address, and loan number for each (lenders require this on the policy)

Property Loss History

No property losses in the last 5 years

Describe each loss — date, cause, amount paid, and what you changed afterward

Tools, equipment & installation

Your property policy stops at the building. This is what covers equipment on a job site, in transit, and material you've installed but haven't been paid for yet.

Scheduled Equipment Anything worth roughly $2,500 or more — carriers want it itemized

Total Scheduled Equipment Value calculated for you

Unscheduled & Blanket Limits

Small Tools Blanket Limit (items under the scheduling threshold)

Max Value Any One Small Tool

Leased / Rented Equipment Limit (rental contracts make you liable for these)

Max Value Any One Rented Item

Employee Tools Limit

Property in Transit Limit

Deductible

Installation Floater Materials you've installed or staged but don't own yet

Limit Any One Job Site

Largest Job Value in the Next 12 Months

Typical Time Material Sits On Site

Is equipment ever left unattended overnight at a job site?

Yes No

What security is in place? (fencing, lighting, GPS trackers, locked conex, cameras)

Any tool or equipment theft losses in the last 3 years?

Yes No

When, what was taken, amount, and what changed since

Excess & umbrella liability

An umbrella sits on top of your other liability policies, so an underwriter can't quote it without knowing exactly what's underneath. Fill in what you have — if a line is being quoted here too, say so and we'll match it.

Limit Requested

Umbrella Limit *

Self-Insured Retention

Coverage Form

Is this limit being required by a contract, GC, or owner?

Yes No

Who requires it, and what exactly does the contract say? (send us the insurance requirements page if you have it)

Underlying Schedule Required to quote

An umbrella carrier needs the carrier, limits, and dates for every policy it sits above. If we're quoting that line for you in this same application, check the box and skip the rest of the row.

Exposures the Umbrella Must Cover

Do you own or operate aircraft, drones, or watercraft?

Yes No

Describe, including whether they're separately insured

Do you perform any design, engineering, or design-build work?

Yes No

Describe (umbrellas exclude professional liability — you may need separate E&O)

Any work on bridges, tunnels, dams, high-rise, or in a rail right-of-way?

Yes No

Describe the project type and your scope

Has any umbrella or excess carrier declined, cancelled, or non-renewed you in the last 5 years?

Yes No

Carrier, date, and reason given

Review before you sign

Here's every line you asked us to quote and whether it's ready to go to market. Anything marked “Needs attention” still needs an answer — click through to fix it.

Coverage Requested

Anything Else We Should Know

Notes for your agent (optional)

Prior insurance, losses & signature

Almost done. Tell us about your prior carriers, any losses in the last 5 years, anyone we need to name as additional insured / certificate holder, and sign.

Prior Carrier Information most recent first · 125 · Prior Carrier Info

List up to three prior years across General Liability, Auto, Property, and any other lines.

Year 1 Most recent prior year

Policy Year

Line of Business

Carrier

Policy Number

Premium

Effective Date

Expiration Date

Year 2

Policy Year

Line of Business

Carrier

Policy Number

Premium

Effective Date

Expiration Date

Year 3

Policy Year

Line of Business

Carrier

Policy Number

Premium

Effective Date

Expiration Date

Loss History past 5 years · 125 · Loss History

The easiest way to handle this is to send us the loss runs and let us read them. Your current agent or carrier can email them to you — ask for “currently valued loss runs, last 5 years.” You do not need to interpret them.

Check here if there have been no losses in the past 5 years

#	Date of Occurrence	Line	Type / Description	Date of Claim	Amount Paid	Amount Reserved	Subro Y/N	Claim Open Y/N
1
2
3

Additional Interests certificate holders, additional insureds, loss payees

Arizona Fraud Notice

Applicable in Arizona: For your protection, Arizona law requires that any person who, with the intent to defraud or knowing that they are facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

Applicant Acknowledgement & E-Signature

By signing below, you confirm that the information you've provided is true, complete, and correct to the best of your knowledge — and you consent to electronic signature.

Applicant Name (printed) *

Title *

Type your full legal name to sign *

By typing your name, you agree this constitutes your electronic signature on this application.

Signature Date *

I confirm the answers are true, complete & correct to the best of my knowledge.

Contractor insurance application: Your application.
Built around your work.

What coverage do you need?

Tell us about your business

Business structure & operations

Premises details

Coverage requested

Operations breakdown

General liability specifics

General business background

Project history

Rating information & payroll

Common GL classifications for your trade

Subcontractor management & risk transfer

Quality control & job site safety

Coverage history & background

Developers supplemental

Commercial auto

Workers' compensation

Common codes for your trade

Property & building coverage

Tools, equipment & installation

Excess & umbrella liability

Review before you sign

Prior insurance, losses & signature

Thank you.
We have your application.

Contractor insurance application: Your application.Built around your work.

What coverage do you need?

Tell us about your business

Business structure & operations

Premises details

Coverage requested

Operations breakdown

General liability specifics

General business background

Project history

Rating information & payroll

Common GL classifications for your trade

Subcontractor management & risk transfer

Quality control & job site safety

Coverage history & background

Developers supplemental

Commercial auto

Workers' compensation

Common codes for your trade

Property & building coverage

Tools, equipment & installation

Excess & umbrella liability

Review before you sign

Prior insurance, losses & signature

Thank you.We have your application.

Contractor insurance application: Your application.
Built around your work.

Thank you.
We have your application.