Contractor Insurance Renewal

Insurance Renewal Questionnaire for Contractors

Contractor Insurance RenewalDonna Howard2024-04-14T14:33:26-05:00

Primary Insured's Name(Required)

First Last

Primary Email(Required)

Business Name(Required)

Main Class Code(Required)

Contractors License#

No license required if not in California.

Federal Tax ID Number(Required)

Please provide a Detailed Scope of Work(Required)

If you would like to add an emergency contact, please provide name and contact information.

Years of Experience Owning This Business

Years of Experience Working In This Field

What are your Estimated Gross Receipts for the Coming Annual Term(Required)

What is your Estimated Sub Payout for the Coming Annual Term(Required)

What is your Estimated Payout for Uninsured Subs for the Coming Annual Term(Required)

What is your Payout to Employees that Work in the Field(Required)

Please click box/es for any information that needs to be updated on your renewal; boxes to input the information will appear below:

None

Business Name or DBA

Business Structure

Address

New Additional Insured(s)

Business Information

New Business Name or DBA(Required)

New Business Structure Type(Required)

Addresses

Type of Address Change(Required)

Physical

Mailing

New Physical Address(Required)

Street Address Address Line 2 City State ZIP Code

New Mailing Address(Required)

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

Do you have a new additional business location?

Yes

Location 2: Address(Required)

Street Address Address Line 2 City State ZIP Code

Location 2: Need Business Personal Property?

Yes

Add a 3rd Location?

Yes

Location 3: Address(Required)

Street Address Address Line 2 City State ZIP Code

Location 3: Need Business Personal Property?

Yes

Add a 4th Location?

Yes

Location 4: Address(Required)

Street Address Address Line 2 City State ZIP Code

Location 4: Need Business Personal Property?

Yes

Additional Insured(s) Information

Please tell us about your new Additional Insureds requirements

Additional Insureds Documents

Drop files here or

Max. file size: 1 MB.

Wrapping Up

Would you like a quote for any additional insurance products?

Workers Compensation

Commercial Auto

Inland Marine (Tools)

Bonds

All of the above

Additional Comments

Additional Documents

Drop files here or

Max. file size: 1 MB.

CAPTCHA

Section Break

Phone

This field is for validation purposes and should be left unchanged.

Texas Office

PO Box 454

Van Vleck, Texas 77482

Phone: 713-589-5498
Fax: 713-456-2950

Office Hours:
Monday – Friday, 9am – 5pm

Bierwirth Insurance Agency is dedicated to providing contractors with personalized insurance solutions in Texas that fit your unique needs as a Builder. General Liability, Builders Risk, Commercial Auto. We have what you need and more…

Get Insurance

Resources

For Clients

Google Rating

5.0

Accessibility | Privacy Policy | Cookie Policy | Terms of Service | Sitemap

DISCLAIMER: Informational statements regarding insurance coverage are for general description purposes only. These statements do not amend, modify or supplement any insurance policy. Read your policy or consult with your agent for details. Your eligibility for particular products and services is subject to final underwriting and acceptance by the insurance company providing such products or services.

This website does not make any representations that coverage does or does not exist for any particular claim or loss, or type of claim or loss, under any policy. Be sure to read the policy, including all endorsements, or prospectus, if applicable.