Fall River - 508.675.2361
Westport - 508.675.2361
New Bedford - 508.999.4941
Home Insurance Services Online Quote Requests About Us Carriers Directory Locations Contact Us

Online Quote Request

Business Contractors Quote

A member of the Pacheco Insurance staff will personally develop a quote suited to your particular insurance needs. We value our customers and take pride in the personal attention we provide.

Please click to review our Website Privacy Policy.

Fill out the form below to obtain a customized Business Contractors quote.

*Required.

Applicant Information

Company Name*:
Name*:
Street:
City/State/Zip: / /
Home Phone:
Work Phone:
Email Address*:

General Information

Organization Type:
If other (please describe):
Contractor Type:
Any operation or property that is owned, leased or occupied that is not covered by this policy? : Yes   No
If Yes, please describe:
Have you declared bankruptcy or had any financial problems in the past 7 years? Yes   No
If Yes, please describe:
Do you perform more than 10% of your work in a state other than your state of domicile? Yes   No
If Yes, please describe:
Total number of employees including Owners Officers/Partners:
Total number of employees:
(not including Owners/Officers/Partners)
Total payroll: $
Number of years experience:
Percentage of work performed within 50 miles of your base of operations: %
Amount of sales receipts for current year: $
Amount of sales receipts for prior year: $
Percentage of work which is residential : %
Percentage of work which is commercial: %

Complete if Residential or Remodeler Contractor

Do you require to be named as an Additional Insured on the subcontractor's policy? Yes   No
If No, please explain:
Do you ever act as a Construction Manager? Yes   No

If Yes, annual fees:
$
Description:

General Liability - Complete if Residential or Remodeler Contractor

Do you have any owned autos? Yes   No
Do you build/remodel condominiums or multi-family dwellings? Yes   No
If Yes, please describe:
Do you build/remodel commercial buildings exceeding 10,000 square feet? Yes   No If
If Yes, please describe:
Number of Housing Starts: Current Year
Prior Year
Percentage of work which is New Construction: %
Percentage of work which is Remodeling: %

General Liability - Complete if Trade Contractor

Do you have any owned autos? Yes   No
Do operations include tunneling or trenching work deeper than 3 feet? Yes   No
Do you contact utility services prior to digging or working with overhead wires? Yes   No
If No, please explain:
Do you perform dam or levee work or have you done so in the last 10 years? Yes   No
If Yes, please describe:

Do you perform work at landfill sites or have you done so in the last 10 years? Yes   No
If Yes, please describe:
Do you perform any railroad track/trackbed construction, repair or maintenance or have you done so in the last 10 years? Yes   No
If Yes, please describe:
Do you install any automatic sprinkler or fire suppression systems or have you done so in the last 10 years? Yes   No
If Yes, please describe:
Do you install fire alarms or smoke detectors or have you done so in the last 10 years? Yes   No
If Yes, please describe:
Do you install or repair gas mains (excluding hose connections) or have you done so in the last 10 years? Yes   No
If Yes, please describe:
Do you install, service or repair high pressure boiler systems or have you done so in the last 10 years? Yes   No
If Yes, please describe:
Do you apply "Exterior Insulation Finish Systems"(a/k/a "Synthetic Stucco") or have you ever done so in the past? Yes   No
If Yes, please describe:
Any remodeling involving foundation, structural changes or movement of load bearing walls? Yes   No
If Yes, please describe:
Minimum General Liability limits required of subcontractors: $ Per Occurrence

$ Aggregate

Contractors Equipment - Complete if requesting this coverage

Any Mobile Equipment?: Yes   No
If yes, please complete below.

Does operator have less than 2 years experience in operating the equipment? Yes   No
If Yes, please comment:


Does this mobile equipment have any maintenance program in place? Yes   No
If Yes, please describe:
Is equipment secured and protected when not in use? Yes   No
If Yes, please describe:

Response Method

I would like my quote sent to me via: Email
Telephone
Snail Mail
Fax
Fax Number:
Mailing Address:
Street:
City/State/Zip:

/ /
How did you hear about us?:  Boston.com
 Internet Yellow Pages
 Yahoo!
 AltaVista
 Lycos
 AOL
 Northern Light
 Go Network
 HotBot
 Other:
Questions or Comments:
Please enter the security code in the image here*:

Click the Submit button below to send your request.

           

We will send your quote promptly.
Thank you for considering Pacheco Insurance!

Have general questions about your insurance needs? If you would like information on specific types of insurance coverage, but are not yet ready to submit a quote request, send us a message using our online General Information Request. form.

Contact us today for more information.

Copyright 2012. Pacheco Insurance. All Rights Reserved.