Please complete and submit the following form to get your free quote on contractor's insurance. Let's get started!

PERSONAL INFORMATION

Your Name: State:  
Street: City:
Apar #: Zip Code:
E-mail:
Phone Number:

Best time to call:

BUSINESS INFORMATION

Name: State:  MA
Street: City:
Apar #: Zip Code:
Phone Number:

Best time to call:

Bdg Construction:
Business Status:
Business Type:
  If Other:
How Long in Business?

Yrs.Trade Experience:

# of Employees: Full Time:
Part Time:
Use Subcontractors: If yes, answer a-d.
a. Work Subcontracted:
b. Percentage of Subed Work:

c. Annual

Cost of Subs:

d. Obtained Certificates of Ins. from Subs:
Handling/Storage of flamables,explosives, chemicals
If yes, describe:
Mobile Equip.
Annual Receipts:
Location of

bookkeeping records for audit purposes:

Contact Person:
Telephone #:
Street Address:
City: State:
Previous Insurace Carrier: (if any)
Policy Period: From  To
Liability Insurance:
Each Occurrence:
Fire Damage:

Medical Expense:

List all claims that have been submitted against insured
within the past three years:
Additional Info, Remarks,Special Equipment:
If you have any comments or questions please state them:

You will get your quote by E-mail soon.  


Home of.. Vellucci Insurance Agency
657 Cambridge St. - Cambridge MA 02140
Tel: 617-492-4150 - Fax: 617-492-0139