Contractor Insurance for New Mexico

General Liability Insurance - Information Request Form

Company Info

Why so much information?
Contact Name Address
Company Name City
Company Type Zip Code
# of Owners, Members, or Officers Email
Phone

Underwriting Info

Are you licensed? License Type
License #
EIN# Currently Insured?
Provide Detailed Description of your Contracting Operations Name of Carrier
How Long Insured?
Claims in the past 3 years - Please provide details and dates
Years in Business
Years Experience in Field
Percentage of Work Residential Number of Employees
Percentage of Work Commercial Annual Employee Payroll
Annual Gross Sales
Do you Subcontract Work? Do you work on Condos or Town Homes?
If you Subcontract, Percentage Subbed? Do you have a formal written Safety Program?