Welcome to Contractors EZ-App from A&M.
For fast service on your commercial accounts complete the form below and hit the
"Step Two" button. Your submission will be electronically delivered to the next
available Commercial Lines Underwriter.
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Producer Name:
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Producer Code:
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Producer Phone Number:
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Producer Fax Number:
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E-mail Address:
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Agency Contact Name:
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Insured Name:
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Insured's Address:
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Effective Date:
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Has the insured had any claims in the last 3 years?
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Select the Type of Business:
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Applicant's Contractors License #:
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Type of Contractor
(GC, Electrician, Roofer, etc.):
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Enter number of
Owners/Partners:
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Enter the Total Payroll for the Owners:
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Enter Direct employee payroll:
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Enter uninsured subcontractor payroll:
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Enter total insured subcontractor cost:
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Percentage of Residential Work:
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Percentage of Commercial Work:
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Estimated number of new home startups for policy
period:
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Annual estimated gross receipts:
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Select liability limit:
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Had prior insurance:
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Prior Carrier:
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Target Premium:
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Optional scheduled inland marine indication:
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Enter scheduled equipment value
> $500 per Item:
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Maximum $100,000 per item not to exceed $300,000 total insurance value. Note: ACV basis only. $1,000 deductible. Credit available.
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(You will get a summary page to
review before submitting) |
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