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IMPORTANT INFO:
IN ADDITION TO SUBMITTING THIS FORM ONLINE, THIS FORM CAN BE PRINTED AND FAXED TO (212) 937-3923.

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Artisan Contractor Insurance - Submission

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ARM-Capacity of New York, LLC., - Leading the way in contractor insurance coverage!

Complete the following information to obtain a Artisan Contractor Insurance Quote.

 BUSINESS INFORMATION
Name of Corporation/Business:

DBA (if applicable):

Street:

City:

State:      Zip:
  
Business Web Site Address
Year Business Started
Year Operating Under Current Name
Ever Filed Bankruptcy or Reorganization YES NO
Other Biz Names in Last 5 Years YES NO

 EXPERIENCE & BASIC RATING INFORMATION
Please Describe the
Nature of Your Business
# of Owners
# of Employees
Select Classification of Work
     Other Classifications 2
     Other Classifications 3
     Other Classifications 4
Contractors License #
License Type
Years of Experience

 FINANCIAL INFORMATION
Payroll of Employees
Annual Sub Costs
Annual Gross Receipts

 OPERATIONS INFORMATION
Have you been involved in the
original construction or remodeling of:
- Townhomes
- Condos / Coops
- Row Homes
- Developments of 15 or more
  single Family Homes		 YES NO
Do you construct footings or foundations
which may support dwellings or
other structures?		 YES NO
Do you construct slab or monolithic floors? YES NO
Do you construct piers or underpinnings
which may support dwellings or
other structures?		 YES NO
Do you construct retaining walls
which may support dwellings or
other structures?		 YES NO
Do you construct fireplaces or chimneys? YES NO
% of work done as GENERAL CONTRACTOR
% of work done as SUB-CONTRACTOR
% of work done on RESIDENTIAL
% of work done on COMMERCIAL
% of work done for REMODELING
% of work done for RENOVATION
% of work done for REPAIR/MAINT.

 COVERAGE INFORMATION
Losses-Claims in the Last 5 Years? YES No
If Losses and/or Claims
List - Date, Amount Paid and
Description of Each Loss
Liability Limits Requested
       Other Loss Limit
Deductible
       Other Deductible
Would you like Signage / Awning Coverage? YES No

 CURRENT COVERAGE INFORMATION
Current Insurance Carrier
Current Expiration Date
Current Premium

 CONTACT INFORMATION
First Name:

Last Name:

*Email:

Phone:                        Fax:
  
Questions/Comments

When Do You Need Quote?

How Did You Hear About Us?


Thank you for completing this form

ARM-Capacity's Policy on sharing information:

  1. We will only use information provided to assist in obtaining appropriate insurance quotes and coverage.
  2. We will not distribute information to other parties other than for insurance underwriting purposes.

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FAX: 212.937.3923

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888.ARMofNY - 888.276.6369

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