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

Protection, Integrity, and Service
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Quotation for 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.

 

 

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.

Policy Coverage and Disclaimer

Haines & Haines/ T.C. Irons
230 High Street PO Box 158- Burlington, NJ 08016
Phone: 609.387.0606
Fax: 609.387.5337		 708 Stokes Road,
Suite A
Medford, NJ 08055
Phone: 609.953.2282 
Fax: 609.953.7719
W.C. Hughes Agency of  Florence Inc
200 Delaware Avenue, Roebling,  NJ 08554
Phone: 609.499.0237 
Fax: 609.499.4077		 Wesley Insurance Service Agency
200 Delaware Avenue, Roebling,  NJ 08554
Phone: 609.499.0517
Fax: 609.538.4077