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ARTISAN CONTRACTOR

Company Name DBA Entity Type
Contact Name Phone Email
Mailing Address City    
State Zip    
Current Ins Company Policy Number X-Date
Losses in the last four Years
Percentage of Work Performed
Type % Type % Other %
Residential % Commercial %    
New % Remodel %    
Payroll
Number of Active Owners Number of Employees Annual Gross Receipts Sub-Contractor Receipts
Liability Coverage
Liability Limit
 Liability Umbrella
    
Property Coverage
Address Loc 1 City   State   Zip
Year Built Square Footage    
Number of Stories Construction Type   Sprinklered  
Building Limit Contents Limit    
Year Updated    
Electrical Roofing      
Plumbing Heating      
Address Loc 2 City   State   Zip
Year Built Square Footage      
Number of Stories Construction Type   Sprinklered  
Building Limit Contents Limit   % Occupied   %
Year Updated                
Electrical Roofing          
Plumbing Heating          
Contractors Tools & Equipment
List Scheduled Equipment Blinket Amount      
Year Make/Model   Value
Year Make/Model   Value
Year Make/Model   Value
Year Make/Model   Value
Year Make/Model   Value
Year Make/Model   Value
Year Make/Model   Value
Year Make/Model   Value
Year Make/Model   Value
Year Make/Model   Value
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