Artisan Contractor Quote 1 General Information 2 Receipts/Employee/Payroll Info 3 Business Information 4 Additional Comments First Name * Last Name * Applicant DBA Business Address * Business Name *Check if mailing address is different from above Mailing Address * Phone Number* Email Address * 1 General Information 2 Receipts/Employee/Payroll Info 3 Business Information 4 Additional Comments Proposed Effective Date: * Type of Contractor License:* (A) General Engineering Contractor(B) General Building Contractor(C) Specialty ContractorC-2 ¨C Insulation and Acoustical ContractorC-4 ¨C Boiler, Hot Water Heating and Steam Fitting ContractorC-5 ¨C Framing and Rough Carpentry ContractorC-6 ¨C Cabinet, Millwork and Finish Carpentry ContractorC-7 ¨C Low Voltage Systems ContractorC-8 ¨C Concrete ContractorC-9 ¨C Drywall ContractorC-10 ¨C Electrical ContractorC-11 ¨C Elevator ContractorC-12 ¨C Earthwork and Paving ContractorsC-13 ¨C Fencing ContractorC-15 ¨C Flooring and Floor Covering ContractorsC-16 ¨C Fire Protection ContractorC-17 ¨C Glazing ContractorC-20 ¨C Warm-Air Heating, Ventilating and Air-Conditioning ContractorC-21 ¨C Building Moving/Demolition ContractorC-23 ¨C Ornamental Metal ContractorC-27 ¨C Landscaping ContractorC-28 ¨C Lock and Security Equipment ContractorC-29 ¨C Masonry ContractorC-31 - Construction Zone Traffic Control ContractorC-32 - Parking and Highway Improvement ContractorC-33 ¨C Painting and Decorating ContractorC-34 ¨C Pipeline ContractorC-35 ¨C Lathing and Plastering ContractorC-36 ¨C Plumbing ContractorC-38 ¨C Refrigeration ContractorC-39 ¨C Roofing ContractorC-42 ¨C Sanitation System ContractorC-43 ¨C Sheet Metal ContractorC-45 ¨C Electrical Sign ContractorC-46 ¨C Solar ContractorC-47 ¨C Manufactured Housing ContractorC-50 ¨C Reinforcing Steel ContractorC-51 ¨C Structural Steel ContractorC-53 ¨C Swimming Pool ContractorC-54 ¨C Ceramic and Mosaic Tile ContractorC-55 ¨C Water Conditioning ContractorC-57 ¨C Water Well Drilling ContractorC-60 ¨C Welding ContractorC-61 ¨C Limited SpecialtyD03 - AwningsD04 - Central Vacuum SystemsD06 - Concrete Related ServicesD09 - Drilling, Blasting and Oil Field WorkD10 - Elevated FloorsD12 - Synthetic ProductsD16 - Hardware, Locks and SafesD21 - Machinery and PumpsD24 - Metal ProductsD28 - Doors, Gates and Activating DevicesD29 - PaperhangingD30 - Pile Driving and Pressure Foundation JackingD31 - Pole Installation and MaintenanceD34 - Prefabricated EquipmentD35 - Pool and Spa MaintenanceD38 - Sand and Water BlastingD39 - ScaffoldingD40 - Service Station Equipment and MaintenanceD41 - Siding and DeckingD42 - Sign InstallationD49 - Tree ServiceD50 - Suspended CeilingsD52 - Window CoveringsD53 - Wood TanksD56 - Trenching OnlyD59 - Hydroseed SprayingD62 - Air and Water BalancingD63 - Construction Clean-upD64 - Non-specializedD65 - Weatherization and Energy ConservationASB ¨C Asbestos CertificationHAZ - Hazardous Substance Removal Certification Projected Gross ReceiptsAnnual Gross Receipts (past 3 years) Next 12 months* * * * Number of owners/partners: * # Full time employees: * # Part time employees: * Total Employee Payroll (no owner, clerical or sales): * Sub-Contracting Costs: * Business Status:*---New in business1-60 Days with no GL CoverageMore than 60 Days with no GL Coverage or no prior coverage1 Year in business with no lapses of coverage2 Years in business with no lapses of coverage3 Years in business with no lapses of coverage4 Years in business with no lapses of coverageOther 1 General Information 2 Receipts/Employee/Payroll Info 3 Business Information 4 Additional Comments Business Experience in Years:* Number of Years in this Business:* Business Type* ---CorporationLLCIndividualOther Contractor License Number: (if none please advice):Carrier name information - past 4 years (if none please advise) Carrier Policy Number (Optional) Premium ($):::: What percentage of work is:Structure Type: Residential:*Industrial:*Commercial:* (Must Equal 100%) Total MUST be 100% Construction Type: New:*Structural remodel/additions:*Service/Repair:*Non-structural remodel:*(Must Equal 100%) Total MUST be 100% Description of the Largest Current/ Planned Job: Value of the Largest Current/ Planned Job: * Description of the Largest Job in the last 3 years: Value of the Largest Job in the last 3 years: 1 General Information 2 Receipts/Employee/Payroll Info 3 Business Information 4 Additional Comments Additional Comments Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough fields above, please enter them here. *I Accept the Privacy Policy & Terms & Conditions