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.

First Step
Second Step
Third Step
Fourth Step

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

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

Who are we sending the approved quote too?

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 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.)