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Welcome to our 3 Minute Sign-Up Process. Please fill out the form to the best of your ability.

This Start-Up package is required in order to receive a final underwriting approval.

Lets get started, we approve 96% of applicants, your next?

How many of Employees do you have in each section?

What is the average weekly payroll for each section?

Work-Site Employees?
(Construction etc.)
Clerical Employees?
(Never leave the office.)
What is the average weekly payroll for each section?

Who are we sending the approved quote too?

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# Yes No If Yes, Please Explain
Does applicant own, operate or lease any aircraft/watercraft?
Any present operations which involve exposure to chemicals, lead based paint, or hazardous materials?
Any work performed under, on, or above water?
Any work which may be subject to Jones Act, USL&H, or FELA?
Any work performed underground or 20 feet above ground level? (If Yes, detail max. height and max. depth)
Any operations include excavation, tunneling, road boring, earth moving, or other underground work?
Any fatalities in the past five years?
Is applicant involved in any business other than that specified in the description of operations?
Do employees travel out of state or out of the country? If so, scope of travel?
Are any group travel or ride-sharing programs provided?
Does the radius of operations vehicles exceed 200 miles?
Is there any framing, roofing, or structural operations? If, so, please explain.
Is a written safety program in place?
If "yes", what is the schedule of safety meetings?
Has applicant been inspected by OSHA in the past three years?
Was applicant cited for any violations? (If Yes, explain.)
Was applicant fined? If so, how much?
Are any subcontractors used? (If Yes, what percentage of work is subcontracted? Also, what type of work?)
If any tree trimming work is performed, are any climbers or bucket trucks used?
If any roofing work is performed, is any hot tar or hot mops used? (If Yes, what is the percent of all work performed?)
Please provide the percentages of commercial and residential work.
Any prior coverage declined, cancelled or non-renewed in the past three (3) years? (If Yes, please provide details.)
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Your Submission was PREAPPROVED!

You have qualified for additional benefits.

YOUR NEXT STEPS

  • One of our brokers will review your information.
  • A same day quote will be generated.
  • You will be contacted when the quote is generated and emailed to you today.
  • Please have your quote on hand.

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