Contractors Insurance Quote

Contractors Insurance QuoteGravity Certs2025-03-26T17:41:18-07:00

"*" indicates required fields

Application Information

Applicant Name*

First Last

Email*

Phone*

Business Information

Proposed Policy Effective Date*

Legal Business Name*

Business Structure*

DBA

FEIN

Business Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address*

Same as Business Address

License Information

Contractors License or Application Fee Number

No license required

Classifications

Choose your primary class code. You may add up to 4 additional class codes to describe your business.

Class Code 1*

Class Code 1: % of Work*

Please enter a number from 0 to 100.

Add 2nd class code

Class Code 2

Class Code 2: % of Work

Please enter a number from 0 to 100.

Add 3rd class code

Class Code 3

Class Code 3: % of Work

Please enter a number from 0 to 100.

Add 4th class code

Class Code 4

Class Code 4: % of Work

Please enter a number from 0 to 100.

Add 5th class code

Class Code 5

Class Code 5: % of Work

Please enter a number from 0 to 100.

Total % of Work

Percent must add up to 100

Business Information

How many years has the applicant's current company been in business?*

Applicant's industry experience*

Insurance History*

Number of Active Owners*

Annual Gross Receipts*

Does Applicant Have Employees?

Yes

Number of Employees*

Please enter a number greater than or equal to 1.

Annual Employee Payroll*

Does Applicant Hire Subcontractors?

Yes

Annual Subcontractor Costs*

Percent of RESIDENTIAL work performed*

Please enter a number from 0 to 100.

Does Applicant perform residential work prior to the certificate of occupancy?

Yes

Percent of NEW work performed*

Please enter a number from 0 to 100.

*prior to approval for occupancy.

Percent of REMODELING work performed*

Please enter a number from 0 to 100.

*prior to approval for occupancy.

Total*

Percent must add up to 100

Please briefly describe your business*

File Attachments

Drop files here or

Max. file size: 12 MB.

Wrapping Up

How were you referred to us?

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Would you like a quote from a specific agent?

All the above information is accurate and true to the best of my knowledge*

Yes

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Phone

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Office Address

6950 SW Hampton St Suite 340

Tigard, Oregon 97223

Phone: 503-601-0350
Email: admin@insurancecci.com

Text us: 503-420-3985

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Proudly providing insurance services to businesses in Oregon, Washington, and Nevada.

Oregon #6263602
Agency License #0100210477

Assurety Insurance & Consulting and Risk Insurance Partners are divisions of Clear Choice Insurance, LLC.

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DISCLAIMER: Informational statements regarding insurance coverage are for general description purposes only. These statements do not amend, modify or supplement any insurance policy. Read your policy or consult with your agent for details. Your eligibility for particular products and services is subject to final underwriting and acceptance by the insurance company providing such products or services.

This website does not make any representations that coverage does or does not exist for any particular claim or loss, or type of claim or loss, under any policy. Be sure to read the policy, including all endorsements, or prospectus, if applicable.

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