Contractor Insurance Renewal

Insurance Renewal Questionnaire for Contractors

Contractor Insurance RenewalGravity Certs2024-08-17T17:16:38-07:00

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.

Years of Experience Owning This Business

Years of Experience Working In This Field

Any change(s) to your business from the previous year?

None

Business Name or DBA

Business Structure

Address

Gross Sales or Revenue

Add or Remove Employee Payroll

Add or Remove Subcontractors

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

Gross Sales and Revenue

Please tell us about your new gross sales and revenue(Required)

Employee Payroll

Add Employee Payroll

Remove Employee Payroll

Subcontractors

Add Subcontractors

Remove Subcontractors

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.

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Phone

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

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Northridge, CA Office

8300 Tampa Ave. Ste J

Northridge, California 91324

Phone: 818-453-8356

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CA license #6003731

Hours

Hours of Operation:
M-Th: 8:30 – 5:30
F: 8:30 – 2:00

Email:
service@martinezagent.com

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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.

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Fraud is a crime

If your application contains purposefully misleading, absent, or inaccurate information, you could be charged with fraud. Your insurance carrier could potentially void your policy, or you could face civil or criminal charges or penalties.

Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act, which is a crime.

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Contractor Insurance Renewal