Secure Contractors Quote Request Form

Cover built for the trades — liability for the work you do, protection for your tools and equipment, and the certificates general contractors and clients ask you for.

Only your name, email and phone are required — fill in what you know and we will come back to you for the rest. Nothing here is an application and nothing is binding.

Your business Business Name

DBA / Trading AsOnly if different from the name above.Business Structure

Business Address

CityZIP Code

Mailing AddressOnly if your mail goes somewhere else.

Your First NameYour Last Name

Email AddressPhone Number

Years in BusinessApproximate Annual RevenueA rough figure is fine.

WebsiteIf you have one.

Your trade What Trade or Speciality?

CA Contractor Licence NumberYour CSLB number — the public licence, not a personal ID.Years in the Trade

Annual Gross ReceiptsWhat Share of Work Is Residential?For example 70%.

How you work

Full-Time EmployeesPart-Time Employees

Total Annual PayrollDo You Hire Subcontractors?

Do You Collect Insurance Certificates From Them?Any Ground-Up New Construction?

Any Structural or Foundation Work?Any Roofing or Work Above Three Storeys?

Tools and vehicles

Value of Your Tools and EquipmentNumber of Work Vehicles

The cover you want

Liability Limits You WantMost contracts require $1M per claim / $2M total.Does a Contract Require You to Add Someone to Your Policy?

If Yes, Who?Do You Also Need Workers Compensation Quoted?

Your current cover and timing Any claims in the past 5 years?

Current or Previous InsurerIf you are switching or renewing.What You Pay NowIf you know it.

When Do You Need Cover to Start?

Anything Else We Should Know

This is a solicitation for insurance. Completing this form does not apply for or bind cover. Coverage cannot be bound or changed via this form, e-mail, voicemail, text, or facsimile — only by written confirmation from our office.