Roofing Contractor Insurance Quote
Basic Information
Applicant's Name:
Applicant Mailing Address:
State:
-- Select State --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Applicant's Phone Number:
Web Address:
Inspection Contact:
Phone for Inspection Contact:
Policy Period From:
Policy Period To:
Applicant is:
Individual
Partnership
Corporation
Joint Venture
LLC
Other
Location #1:
Do you have additional locations?
-- Select --
Yes
No
Location #2:
Location #3:
Experience & Operations
Years in Business?
Years of Experience in this field?
Types of Roofing Operations
Indicate the percent of each type of roofing performed. Must equal 100%.
Current Total: 0%
Commercial Operations:
New Construction %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Repair/Patching %:
--
0%
10%
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70%
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90%
100%
Replacement %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Residential Operations:
New Construction %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Repair/Patching %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Replacement %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Industrial Operations:
New Construction %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Repair/Patching %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Replacement %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Warning: The total percentage must equal 100%. Please adjust your selections.
Types of Roofing Materials
Please indicate the percentage of each material type used. The total should equal 100%.
Current Total: 0%
Flat Roofs %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Metal %:
--
0%
10%
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30%
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50%
60%
70%
80%
90%
100%
Pitch Roofs %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Asphalt Shingle %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Single Ply %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Tile %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Fiberglass %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Wood %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Polyurethane Foam %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Hot Tar %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Slate %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Torch Down %:
--
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Warning: The total percentage should equal 100%. Please adjust your selections.
Other - Describe:
Additional Operations & Safety
Describe any other operations or work done other than roofing (e.g., waterproofing, siding, asbestos removal, rain gutters, carpentry, etc):
Has or will any work involve the new construction of condominiums, townhouses, multi-family homes, apartments or tract homes?
-- Select --
Yes
No
If yes, please describe the work?
Number of units in largest project:
Any Current Wrap-Up/OCIP Projects?
-- Select --
Yes
No
If yes, what is the projected cost associated with the Wrap-Up/OCIP Projects?
What is the maximum height of the buildings you work on?
If over 3 stories, does applicant have a fall protection program in place for all jobs including one of the following systems:
Guardrail system with toes boards
Safety net
Personal fall arrest system
Do you have a written safety program?
-- Select --
Yes
No
Financial Information
Owner/Partner Payroll $
Employee Payroll $
Subcontractor Cost $
Uninsured Subcontractor Payroll $
Number of Employees:
Leased Employees Payroll $
Total Gross Sales $
Safety & Procedures
How do you protect the general public from potential injury?
How are materials lifted to the roof?
How are openings in the roof protected over night?
What precautions do you take when a rainstorm is imminent?
Does a foreman or contractor inspect all jobs upon completion?
-- Select --
Yes
No
Have you ever or do you currently perform work in AZ, CA, CO, NV, NY, OR, UT or WA?
-- Select --
Yes
No
Please describe work in these states:
Have you ever used, sold, installed or removed asbestos?
-- Select --
Yes
No
When was the last asbestos-related work?
If yes explain in detail:
Are Cranes used?
-- Select --
Yes
No
Crane Size (Tons):
Boom Length:
Are barriers in place to protect the public?
-- Select --
Yes
No
Are the cranes owned or rented?
Owned
Rented
If owned, is equipment under a regular maintenance schedule?
-- Select --
Yes
No
Are employees properly trained and certified?
-- Select --
Yes
No
Does the applicant have a "fire watch" program to assure there are no "hot spots" after completion of a job?
Describe:
Is applicant complying with all state & OSHA regulations?
-- Select --
Yes
No
Roofing Contractors
Does applicant draw plans, designs or specifications?
-- Select --
Yes
No
If yes, describe.
Do your subcontractors carry coverage or limits less than yours?
-- Select --
Yes
No
If yes, what are the minimum limits you accept?
Are certificates of insurance required from subcontractors?
-- Select --
Yes
No
Do subcontractors list you as Additional Insured?
-- Select --
Yes
No
Is a signed subcontract agreement used with all subcontractors that contains an indemnification and hold harmless clause in your favor?
-- Select --
Yes
No
How long are Certificates of Insurance kept?
If other, provide details:
Describe the type of work subcontracted indicating percent for each category:
Does applicant lease equipment to others with or without operators?
-- Select --
Yes
No
If yes, describe equipment and forward copy of lease agreement:
Full-time Employees:
Part-time Employees:
Three-Year Sales History
Year 2025 Gross Sales $
Year 2024 Gross Sales $
Year 2023 Gross Sales $
Do you offer warranties?
-- Select --
Yes
No
Warranty Period (Years):
Describe warranty coverage:
Contractual Liability
Describe All Hold Harmless Agreements (Dates, Contracting Party, Cost) and attach copies.
Certificate Recipients / Additional Interests
Name and Address #1:
Relationship to Applicant:
Is this recipient an Additional Insured?
-- Select --
Yes
No
Additional Insured Type:
Additional Insured
Lienholder
Loss Payee
Mortgagee
Certificate Required?
Add More Recipients
Name and Address #2:
Relationship to Applicant:
Is this recipient an Additional Insured?
-- Select --
Yes
No
Additional Insured Type:
Additional Insured
Lienholder
Loss Payee
Mortgagee
Certificate Required?
Name and Address #3:
Relationship to Applicant:
Is this recipient an Additional Insured?
-- Select --
Yes
No
Additional Insured Type:
Additional Insured
Lienholder
Loss Payee
Mortgagee
Certificate Required?
Name and Address #4:
Relationship to Applicant:
Is this recipient an Additional Insured?
-- Select --
Yes
No
Additional Insured Type:
Additional Insured
Lienholder
Loss Payee
Mortgagee
Certificate Required?
List Three (3) of Your Largest Jobs and Type of Process Used in the Last Five (5) Years
Jobs #1:
Type of Process Used:
Jobs #2:
Type of Process Used:
Jobs #3:
Type of Process Used:
Additional Information or Comments
Please send a copy of Hold Harmless Agreements, Warranties and Sub Contractor agreements to Quotes@RoofingContractorInsuranceDirect.com
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