Insurance Needs Survey | Pascal Burke Insurance Brokerage Inc.

Contractors’ Insurance Needs Survey

By completing a short questionnaire, the “Insurance Needs Survey will provide you with a detailed report of the types of insurance, including limits, key endorsements, and other details you will need to protect your business. This is an excellent tool to help you when shopping for contractors’ insurance.

What state is your business located?

Contractor's Insurance Needs Survey

Please signed up to complete insurance calculator form.

Company Name

First Name

Last Name

Address

City

Zip Code

Email Address

Phone Number

By clicking "Next" I agree to receive emails, text message, and phone calls, which may be recorded and/or emailing equipment or software unless I opt-out from such communications.
-Purpose of the message: To send a follow-up text message regarding insurance proposal we forwarded to you once you completed this form.
-It's great to know that you can opt out of receiving these SMS texts at any time simply answering STOP. You can get more information by just answering HELP. We do not sell or share your information with third parties. You may always check our company's privacy policy here and terms and conditions here. Finally, data charges may apply to any SMS texts you receive. Thank you.
-Subsequent follow-ups can take place 10 days and a month after the initial quote transmission.
-No mobile information will be shared with third parties/affiliates for marketing/promotional purposes.

Contractor's Insurance Needs Survey

Please signed up to complete insurance calculator form.

Do you perform any residential work?
Do you perform any commercial work?
Do you have employees?
Do you use a vehicle in your work, or do your employees, if any, use their own vehicle for their work?
Do you work on property with a value greater than $1,000,000?
Do you rent equipment or do your tools and equipment add up to more than $10,000?
Do you own or rent an office, warehouse, or yard facility other than your home?

Multiple selections *

Contractor's Insurance Needs Survey

Please signed up to complete insurance calculator form.

Do you maintain all licenses as required by any local or state authorities for providing contracting services?
Are you a General Contractor that performs remodeling or additions, or new ground up construction for residential or commercial building?
Do you transport materials, and or store them at your facility or jobsite, with a value greater than $10,000?
Do you perform any of the following services: Design Build, architectural, engineering services or construction management for a fee?
Do directly or through your website collect any personal information from your customers; credit card information, phone number, address, checking account, drivers license, social security, date of birth?
Do you store, transport, or use on the jobsite any pollutants?
Do you use subcontractors?

Multiple selections *

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