Strategic Insurance Services, LLC - Contractors Inquiry Form

Please complete the following information.
Company Name *
Contact Person *
Company Address
Address*
City*
State/Province*
ZIP/Postal Code*
Country*
Phone*
Email*
example@example.com
Website
FEIN#*
Birth Date*

MonthDayYear
Current Insurance Carrier *
Current Insurance Expiration Date
Year Business was Established *
Years of Experience *
Are you an HBA Member? *

YesNo
Do you use a 10-2 Structural Warranty? *

YesNo
Company:
Do you have a Safety Program? *

YesNo
Do you have a Builder License? *

YesNo
Browse Files

Cancelof
Do you us a program that tracks Certificates of Insurance from Subs? *

YesNo
Projected Gross Sales Revenue for the next 12 months *
Projected Sub-Contractor Costs *
Describe the jobs you intend to complete *
(Urban infill, Custom, Production, Multifamily, For Sale, Rentals, etc)
Are you interested in Builders Risk? *

YesNo
Do you need Property Coverage? *

YesNo
Property Coverage Information
Describe the property that needs to be covered.
(Vacant Land, Vacant Home, Office and Contents, etc.)
Property Address
Address
City
State/Province
ZIP/Postal Code
Country
Storage Footage
Year of Building
Is building owned or leased?

OwnedLeased
Alarm/Fire System?

YesNo
Do you have an additional Office or Sales Trailer?

YesNo
Values
Do you have any tools or heavy equipment?

YesNo
Value
Office Contents: How much would you like to insure for?
Specify location of contents
If there is anything unique in the office (i.e. art, antiques, etc) please list
Do you have sales staff, designers, or architects as employees?

YesNo
Do they carry their own Professional Liability or E&O Coverage & what are their limits?
Should be Empty:

Property Coverage Information