Contractor Survey - Hutch

Contractor Survey – Hutch

Business

Business name:

Legal entity:

Number of employees:

Contact name:

First Last

Phone:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Other location(s):

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email:

Website / Social Media:

Annual sales:

Annual payroll:

Federal tax ID number:

Franchise:

Current carrier:

Years with current carrier:

Policy expiration date:

Number of claims:

Claim(s) details:

Description of operation:

% residential:

% commercial:

States where contracting performed:

List

Employee List (including owner)

Job Duties

Full or Part Time?

Payroll

Driver of Company Vehicles?

Do you use subs?

If yes, do you collect certificates?

If yes, do you require subs to add you as an additional insured?

If yes, do you require that their policy be primary and non-contributory and that they have waived their right to subrogate against your policy?

If the first question “Do you use subs?” is yes, but the answer to the second question “Do you collect certificates?” is no then, do you always use the same subs?

If yes, what percentage of your total payroll is sub costs?

Do you require that your subs maintain a minimum of $1M per occurrence general liability limit?

Have you owned any other business in the last 5 years?

If yes, describe:

% of residential work:

% of commercial work:

Do you do any of the following: blasting, EFIS, off-premises welding, mold remediation, demolition, fire sprinkler installation or repair, street/road paving, or roofing?

Do you use written contracts for all jobs performed?

If no, please provide further information:

List

List Last Five Jobs Completed:

Job Done For:

% Subcontracted:

List

Subcontractors Used:

Job Duties:

Cost:

Certificate of Insurance?

General Liability Limit

Select one:

Umbrella?

Rating basis:

Sales / Receipts:

Payroll:

Data Breach liability:

Employee benefit liability:

Employment practices liability:

Deductible:

Number of Employees (full-time):

Number of Employees (part-time):

Third-party coverage?

Property

Blanket

Deductible amount:

Coinsurance amount:

Replacement cost value:

Actual cash value:

Building value:

BPP / Contents:

Additional Property (signs, lights, clocks, fences, playgrounds, etc.)

Physical address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

County:

Construction type:

Year built:

Year of roof:

Total square footage:

Your square footage:

List other tenants:

Workers’ Compensation

Expert modification factor:

Expert modification date:

Sole proprietor / Partners coverage?

Corporate officer coverage?

List

Class code #:

Payroll =

Average length of employment:

Safety:

(check all that apply)

Eye washing stations?

Autos

Auto used in business?

Autos titled to?

Hired / Non-owned?

Do your corporate officers maintain a personal auto policy?

If no, consider adding the corporate officers named coverage endorsement.

Included at direct primary

Limit is actual loss

Liability

Med Pay

Um / Uim

Comp

Coll

List

Year

Make

Model

VIN