BR Quote Form
Contractors General Liability
Enter information about your business, the more detailed the information the better the quote. Items with a red asterisk are required. All other item can be skipped if needed. Detail boxes will open when further explanation is needed, the pop up can be clicked to toggle off.
Indicates required field
Location Address (If different from mailing)
Limited Liability Company
Enter the year this business was established
Enter your number of years experience in this field of work.
Are you a licensed Contractor
How did you find us?
Reply to Email I received
Contractor License Number (if you are licensed)
Describe Your Business
Employer or Tax ID Number
Liability Limits Requested
Other limit needed - Call Me
Name of Insurance Company & Expiration Date of Policy
Estimated Annual Gross Revenue
List your estimated gross revenue (all income before any expenses) that you expect within the next 12 months (from today forward).
Any prior claims or losses
List any losses within the last three years
Describe prior losses or claims
Percentage of work residential
Percentage of work commercial
Percentage of New Construction
Enter your percentage of work for both residential and commercial new construction.
Percentage of Remodeling
Enter your percentage of work for both residential and commerical remodeling.
Number or Owners
Enter the total number of owners, partners, members or officers
Enter total annual payroll for all owners
Number of Employees
Enter only W2 employees do not count any 1099 paid employees.
Enter total annual payroll for all W2 employees
Do you use sub contractors
Insured Sub Cost
Total annual payroll of insured subs. Most companies count labor and material.
Uninsured Sub Cost
Total annual payroll of all uninsured subs. Most companies count labor and material.
Check all items that pertain to your subs
Sub must be insured
My company is listed as additional insured on subs insurance
Sub signs hold harmless agreement with my company
Some of my subs are uninsured
All of my subs are uninsured
Check all items that pertain to your work
New Home Construction
New or Re-Roofing
Roofing in association with room additions only
Check the category that best describes your work
Painting Interior & Exterior
Electrical work within buildings
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