TC Irons Artisan Contractor Insurance Quotation

Privacy Policy-We routinely collect personal and/or business information that is needed as part of the quoting and underwriting process. We also collect the same information as part of service and update activities. The Haines & Haines/T.C. Irons Agency will not share that information, or use it in any other way, with outside parties, vendors, etc.

Artisan Contractor Insurance

BUSINESS INFORMATION

Name of Corporation/Business:

DBA (if applicable):

Street:

City:

State: Zip:

Business Web Site Address
Year Business Started
Year Operating Under Current Name
Ever Filed Bankruptcy or Reorganization?	YES NO
Other Business Names in Last 5 Years	YES NO

EXPERIENCE & BASIC RATING INFORMATION
Please Describe the Nature of Your Business
# of Owners
# of Employees
Select Classification of Work
Other Classifications 2
Other Classifications 3
Other Classifications 4
Contractors License #
License Type
Years of Experience

FINANCIAL INFORMATION
Payroll of Employees
Annual Sub Costs
Annual Gross Receipts

OPERATIONS INFORMATION
Have you been involved in the original construction or remodeling of: - Town homes - Condos / Co-ops - Row Homes - Developments of 15 or more single Family Homes	YES NO
Do you construct footings or foundations which may support dwellings or other structures?	YES NO
Do you construct slab or monolithic floors?	YES NO
Do you construct piers or underpinnings which may support dwellings or other structures?	YES NO
Do you construct retaining walls which may support dwellings or other structures?	YES NO
Do you construct fireplaces or chimneys?	YES NO
% of work done as GENERAL CONTRACTOR
% of work done as SUB-CONTRACTOR
% of work done on RESIDENTIAL
% of work done on COMMERCIAL
% of work done for REMODELING
% of work done for RENOVATION
% of work done for REPAIR/MAINT.

COVERAGE INFORMATION
Losses-Claims in the Last 5 Years?	YES No
If Losses and/or Claims List - Date, Amount Paid and Description of Each Loss
Liability Limits Requested
Other Loss Limit
Deductible
Other Deductible
Would you like Signage / Awning Coverage?	YES No

CURRENT COVERAGE INFORMATION

Current Insurance Carrier

Current Expiration Date

Current Premium

CONTACT INFORMATION
First Name Last Name Email Phone Fax Questions / Comments / Notes
Send my quotation via	E-Mail Fax Regular Mail Call me by Phone!

All quotes are based on the information that the applicant provides, and are subject to change based on final underwriting by the individual carriers.

Our Mission Statement

Dating back from 1872 our mission is clear:

To serve our clients with the utmost respect, integrity and professionalism while providing a comprehensive risk management program at competitive pricing

Policy Coverage
and Disclaimer

Contact

	Haines & Haines/ T.C. Irons
16 West Front Street Florence, NJ 08518 Phone: 609.499.0237 Fax: 609.499.4077	230 High Street PO Box 158- Burlington, NJ 08016 Phone: 609.387.0606 Fax: 609.387.5337	1-3 Bank Street Suite E Medford, NJ 08055 Phone: 609-953-2282 Fax: 609.953.7719
	Wesley Insurance Service Agency 1194 Parkway Avenue Trenton, NJ 08628 Phone: 609.883.4190 Fax: 609.538.0274