General Liability

Contractor's Application

If you have any questions feel free to contact us at 909-881-2654.

Name:
Email Address:
Business Address:
Fax Number:
Business Website:
Entity Type:
If Other Please Explain:
Name of Owner/Officers:
Operation is:	General Contractor Artisan Contractor Sub Contrator
What % of each:
Contractors License Number, Type and State:
Years in Business:
Describe your Operations:
Type of Work Performed:	Residential (New Construction - including tract,townhouse, condo, spec or custom) Commercial (New Construction) Industrial (New Construction) Residential (Remodel, Repair, Service) Commercial (Remodel, Repair, Service) Industrial (Remodel, Repair, Service)
What % of each:
Do You Use Subcontractors:	Yes No
If Yes, What Percentage:
Sub Costs:
Do You Have Employees:	Yes No
If Yes, How Many:
Total Payroll:
Annual Receipts/Sales: Current Year:
Previous Year:
Two Years Ago:
List Three Current or Planned Projects, Please Also List Each Job Cost, and Job Duration:
List Your Three Largest Jobs, Please Also List Each Job Cost, and Job Duration:
Describe Types of Equipment Used:
Do You Use Written Contracts With Customers:	Yes No
If No, Please Explain:
Do You Use Written Contracts With Subcontractors:	Yes No
If No, Please Explain:
Do You Have Workers' Compensation in Force:	Yes No N/A
Do you work as a construction/project manager or consultant:	Yes No
If Yes, Please Explain:
Have you been involved in or aware of any pending construction defect claims:	Yes No
If Yes, Please Explain:
Do You Currently Have Insurance In Place:	Yes No
If Yes, Please Provide the Following: Type of Policy, Carrier Name, Expiration Date, Premium, Limits:
Were you referred by someone? If yes please list who referred you: