Donoyan Insurance Agency, Inc.

After completing this form, please click the SUBMIT button to receive your free Insurance Quote.

You'll be given an opportunity to specify U.S. Postal Service, e-mail or fax.
Or call us toll-free at 877-DONOYAN (366-6926).

*indicates required fields

*Contractor Type

*Contact Name

*E-mail

*Company

*Street Address

*City

County

State

*Zip Code

Home Phone

Work Phone

FAX

The following are guidelines for this contractors business program:

No General Contractors

No new construction for tracts or subdvisions of 10 or more homes

No new construction (other than remodeling for a single unit) for apartments,
condominiums and townhouses

Applicant is :
Individual   Partnership   Corporation

Description of Operations

Duty of Owner

S.S. Number or FEIN

Contractor License #

Number of Employees (Excluding Owners & Clerical, if any)
Full Time    Part Time

Payroll of Employees (Excluding Owners & Clerical, if any)

Annual Gross Receipts

Years of Experience

Years in Business

Sub-contractors used?

Yes No

Type of Work (Sub-contractors)

Total Cost (Sub-contractors)

Do you get a Certificate of Insurance from Sub-contractor?

Yes No

Need Percent of Work
    Inside Outside (must equal 100%)

Residential Commerical (must equal 100%)

New Construction Remodel/Repair (must equal 100%)

Each Occurrence/Aggregate

*Building Coverage
(Enter zero, if coverage not required)

*Contents Coverage
(Enter zero, if coverage not required)

Deductible

Square Footage
          Year Built

If building is over 30 years old,
must have updates:
     Wiring Date: Renovation

Heating Date: Renovation

Plumbing Date: Renovation

  Roof Date: Renovation

Percent of Property Occupied as:
                 Office % Storage %

  Apartments % Other %

Building Construction:
Frame
Masonry N/C Joisted Masonry
Fire Resistive

Is Building 100% sprinklered?

    Yes No

Does Building have an alarm?

    Yes No

Contractors Equipment
(Minimum value $2,500 per item)
                    Scheduled ($250,000 Maximum values)

Contractors Tools
(Maximum value $2,500 per item)
Blanket / Unscheduled ($25,000 Maximum Values)

Current Insurance

Expiration Date

Premium?

Have you had any home or contents losses within the last three years?

How would you like to receive your free quote?
U.S.Postal E-mail Fax