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 to receive a final underwriting approval.

First Step
Second Step
Third Step
Fourth Step

Let's get started. We approve 96% of applicants. Are you next?

Work-Site Employees? (Construction Etc.)
Clerical Employees? (Never leave the office.)

Who are we sending the approved quote to?

Tell us about your company so we can classify you correctly

What address do we use to approve your policy?

# Yes No If Yes, Please Explain
Does applicant own, operate or lease any aircraft/watercraft?
Any current 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 the Jones Act, USL&H, or FELA?
Any work performed underground or 20 feet above ground level? (If Yes, detail max height and max depth)
Do any operations include excavation, tunneling, road boring, earthmoving, or other underground work?
Any fatalities in the past five years?
Is the 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, the 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 yes, please explain.
Is a written safety program in place? <br> If "yes", what is the schedule of safety meetings?
Has OSHA inspected the applicant in the past three years?
Was the applicant cited for any violations? (If Yes, explain.)
Was the 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 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 completed?)
Please provide the percentages of commercial and residential work.
Any prior coverage declined, canceled, or non-renewed in the past three (3) years? (If Yes, please provide details.)