InsuranceDirect.com | Roofing Contractor GL Quote

Business Name

Contact Name

Email Address

Business Type

Physical Address

Mailing Address (if different)

Business Website

FEIN Number (if available)

Company Type (Corp, LLC, etc)

Policy Effective Date

Is this a new venture? Yes No

Years of Experience

Do you have insurance now? Yes No

Type of Roofing Work Performed

Work Type	Residential (%)	Commercial (%)
New Construction
Repair/Patching
Replacement

Projects By Roof Types (%)

Roof Type	%
Flat Roofs
ASPHALT SHINGLE
HOT TAR
METAL
TILE
PITCH ROOFS
FIBERGLASS
SINGLE PLY
WOOD
SLATE
POLYURETHANE FOAM
TORCH DOWN
OTHER (Describe Below)

Other Description

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? Yes No

If yes, please describe the work

Any Current Wrap-Up/OCIP Projects? Yes No

If yes, what is the projected cost associated with the Wrap-Up/OCIP Projects?

Describe what safety precautions are in place if hot tar, torch down or other hot processes are used?

What is the maximum height of the buildings you work on?

If over 3 stories, does applicant have a fall protection program?

Guardrail system with toe boards
Safety net
Personal fall arrest system

Do you have a written safety program? Yes No

Owner/Partner Payroll ($)

Subcontractor Cost ($)

Uninsured Subcontractor Payroll ($)

Number of Employees

Employee Payroll ($)

Leased Employees Payroll ($)

Total Gross Sales ($)

How do you protect the general public from potential injury?

How are materials lifted to the roof?

How are openings in the roof protected overnight?

What precautions do you take when a rainstorm is imminent?

Does a foreman or contractor inspect all jobs upon completion? Yes No

Have you ever or do you currently perform work in AZ, CA, CO, NV, NY, OR, UT or WA? Yes No

If yes, please describe:

Have you ever used, sold, installed or removed asbestos? Yes No

If yes, explain in detail:

Are Cranes used? Yes No

If yes, size (Tons) and Boom Length:

Are barriers in place to protect the public? Yes No

Are cranes owned or rented? Owned Rented

If rented, attach rental agreement

If owned, is equipment under a regular maintenance schedule? Yes No

Are employees properly trained and certified? Yes No

Upload Additional Supporting Documents (PDF, DOCX, JPG)

Does the applicant have a “fire watch” program to assure there are no “hot spots” after completion of a job? Yes No

Describe fire watch program:

Is applicant complying with all state & OSHA regulations? Yes No

Does applicant draw plans, designs or specifications? Yes No

If yes, describe:

Do your subcontractors carry coverage or limits less than yours? Yes No

If yes, what are the minimum limits you accept?

Are certificates of insurance required from subcontractors? Yes No

Do the subcontractors list the applicant as an Additional Insured? Yes No

Is a signed subcontract agreement used with all subcontractors that contains an indemnification and hold harmless clause in your favor? Yes No (Risk may not be acceptable)

How long are Certificates of Insurance kept? (Years)

Describe the type of work subcontracted indicating percent for each category:

Does applicant lease equipment to others with or without operators? Yes No

If yes, describe equipment and forward copy of lease agreement:

What is the number of employees?

List Gross Sales for the last three years:

Do you offer warranties? Yes No

If yes, attach copies of warranty:

Describe all Hold Harmless Agreements (Dates, Contracting Party, Cost):

Attach Sub Contractor Agreement:

Certificate Recipients / Additional Interests

Name and Address:

Relationship to Applicant:

Additional Insured? Yes No

Certificate Needed? Yes No

List Three (3) of Your Largest Jobs and Type of Process Used in the Last Five (5) Years

Job	Type of Process Used

Brief Description of Operations

Roofing Contractors: GL Insurance Made Easy