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general-liability-application.pdf

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application_date

2024-03-22

application_number

GL-APP-2024-123456

business_name

Premier Construction Services Inc.

dba

Premier Builders

business_address

2500 Contractor Lane, Denver, CO 80201

mailing_address

PO Box 2500, Denver, CO 80202

business_phone

(303) 555-0678

business_email

insurance@premierbuilders.com

fein

84-1234567

business_type

Corporation

date_established

2010-06-15

nature_of_operations

General contractor - commercial and residential construction

sic_code

1522

naics_code

236220

annual_gross_receipts

8500000

annual_payroll

2200000

number_of_employees

subcontractor_costs

3000000

coverage_requested

each_occurrence: 1000000, general_aggregate: 2000000, products_completed_ops: 2000000, personal_advertising_injury: 1000000, damage_to_rented_premises: 100000, medical_expense: 10000

additional_coverages

Blanket Additional Insured, Waiver of Subrogation, Primary Non-Contributory

Work_performed

3 items

description

percentage

Commercial construction

Residential construction

Remodeling

geographic_area

Colorado

prior_carrier

Contractors Insurance Co

prior_policy_number

GL-2023-789012

current_premium

35000

claims_last_5_years

{ "application_date": "2024-03-22", "application_number": "GL-APP-2024-123456", "business_name": "Premier Construction Services Inc.", "dba": "Premier Builders", "business_address": "2500 Contractor Lane, Denver, CO 80201", "mailing_address": "PO Box 2500, Denver, CO 80202", "business_phone": "(303) 555-0678", "business_email": "insurance@premierbuilders.com", "fein": "84-1234567", "business_type": "Corporation", "date_established": "2010-06-15", "nature_of_operations": "General contractor - commercial and residential construction", "sic_code": "1522", "naics_code": "236220", "annual_gross_receipts": 8500000, "annual_payroll": 2200000, "number_of_employees": 35, "subcontractor_costs": 3000000, "coverage_requested": { "each_occurrence": 1000000, "general_aggregate": 2000000, "products_completed_ops": 2000000, "personal_advertising_injury": 1000000, "damage_to_rented_premises": 100000, "medical_expense": 10000 }, "additional_coverages": [ "Blanket Additional Insured", "Waiver of Subrogation", "Primary Non-Contributory"], "work_performed": [ { "description": "Commercial construction", "percentage": 60 }, { "description": "Residential construction", "percentage": 30 }, { "description": "Remodeling", "percentage": 10 } ], "geographic_area": "Colorado", "prior_carrier": "Contractors Insurance Co", "prior_policy_number": "GL-2023-789012", "current_premium": 35000, "claims_last_5_years": 1 }