ZOLOFRA INSURANCE AGENCY

Ready to protect you today for what matters tomorrow.

Contractors Liability Form

CHECK OUT OUR NEW AND IMPROVED WEBSITE AT:

WWW.ALLPROCOVERAGE.COM

 

 

*CONTRACTING OPERATIONS (select all that apply)
General Contractor
Developer
Owner/Builder
Subcontractor
Construction Manager
Consultant

*Have you operated under any other names?
Yes
No

*Present or prior affiliation with any other firms?
Yes
No

*Has any insurer ever cancelled, restricted or refused to renew your General Liability policy?
Yes
No

*Types of construction operations:
New Construction
Commercial
Remodeling
Residential
Repair
Industrial
Demolition
Instiutional
Other


*Any past, present or future work on hillsides, hilltops or terraces?
Yes
No
*Any past, present or future work on landfill areas or in subsidence areas?
Yes
*Any past, present or future construction operations conducted in excess of 2 stories?
Yes
No
*Any past, present or future exterior work performed above 2 stories in height from grade?
Yes
No
*Any past, present or future work performed below grade?
Yes
No
*Any past, present or future involvement in the construction of condos, townhouses or apartments?
Yes
No

*Any past, present or future involvement with EIFS or Synthetic Stucco?
Yes
No

*Any past, present or future involvement in the building of Tract Housing Developments? (Tract defined as 6 or more homes in the same subdivision)
Yes
No
*Have you worked or will you or your employees work under USL&H or Jones Act?
Yes
No
*Do you have a formal safety program in operation?
Yes
No

*Do you use subcontractors?
Yes
No
*Are certificates of insurance obtained from subcontractors?
Yes
No
*Are written contracts obtained from all subcontractors which include a hold harmless clause in your favor?
Yes
No

*Do you draw any plans or blueprints used in your construction work?
Yes
No
If yes, has Professional Liability Coverage been obtained?
Yes
No
*Do you own any vacant land held only for investment of possible development more than 12 months future?
Yes
No
*Do you own any real estate development property (land with improvements-streets, roads or utilites, etc....completed under construction?
Yes
No

*Have you had any claims the last 5 years?
Yes
No

*Any subsidence or sinkhole related losses in the past 5 years?
Yes
No

*Have you ever been named in a construction defect suit?
Yes
No

*Are you aware of any other incidents which may result in claims against you?
Yes
No

*Would you like a quick quote for Employment Practices Liability?
Yes
No

 

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Disclaimer Notice - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.

Please utilize the "Submit" Button to send your form to our office.  If the website does not allow you to submit the form, please print the page and fax it to 732.334.0405 or scan it into your computer and send it to ben@zolofrainsurance.com.  Do not "Refresh" the page because all data entered onto the form will be lost.