Artisan Contractors Insurance

We can write either standard or Excess and Surplus Artisan Contractors Insurance Policies in the following states:

Texas
Arizona
Oklahoma
Nevada
Florida
Louisiana

877-280-5300

General Information
Name Insured(s):
Applicant DBA:
Contact Person:
Physical Address:
City:	State: Zip:

Mailing Address (if different):
City:	State: Zip:

Insured Telephone:

Receipts/Employee/Payroll Information

Proposed Effective Date:

Description of operation:

Projected Gross Receipts	Annual Gross Receipts (past 3 years)
Next 12 months
$	$	$	$

Number of owners/partners:

Number of:

Full time employees: Part time employees:

Total Employee Payroll:
(no owner, clerical or sales)

$ Sub-Contracting Costs: $

Business Status:

Business Information

Applicants business experience in years:

Number of years in business:

Type of business:

Contractor license number:

(if none please advise)

Carrier name information - past 4 years (if none please advise)
	Carrier	Policy Number	Premium
			$
			$
			$
			$

What percientage of work is:

Structure Type
Residential:	%
Industrial:	%
Commercial:	%


(must equal 100%)	%

Construction Type
New:	%
Structural remodel/additions:	%
Service/Repair:	%
Non-structural remodel:	%

(must equal 100%)	%

Description of Largest Current/
Planned Job:

Value of that job:

Description of Largest job last 3 years:

Value of that job:

Additional Comments

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Steven Goss or another agent will respond to your submission as soon as possible.