Commercial Umbrella Insurance Application

Name: Contractor's Choice Agency
Address: 12220 E Riggs Rd, Suite #104, Chandler, AZ, 85249, US
Telephone: 844-967-5247
Price range: $$

One large claim can exhaust a primary policy. Umbrella and excess liability coverage sits above your existing limits so a single loss does not reach your business.

Higher Limits

Quick Quotes

Local Service

Start Application Download PDF Call: 844-WORK-247

Why Carry an Umbrella Policy?

Limits That Match the Exposure

Millions in additional protection above your underlying policies

Contract Requirements

Many general contractors and owners require umbrella limits to bid

Personal Service

Local agents who understand contractor and trade exposures

What an Umbrella Policy Sits Above

Umbrella and excess liability coverage extends the limits of the policies you already carry, and can broaden coverage where an underlying policy stops short.

Excess General Liability

Additional limits above your underlying CGL policy

Excess Auto Liability

Extra protection above your commercial auto limits

Excess Employers Liability

Higher limits above your workers compensation policy

Broadened Coverage

Drop-down coverage where underlying policies fall short

What Underwriters Will Ask For

Underlying carrier, policy numbers and limits

Annual payroll, gross sales and employee counts

Vehicle schedule by weight class and radius

Products, pollution and contractor exposures

Loss history on the underlying policies

Before You Start

Have your current declarations pages handy

Only name, phone and email are required

Fill in what you know and leave the rest blank

An agent will follow up on anything missing

Attach separate sheets by email if needed

Umbrella Insurance Application

Complete the form below to get your commercial umbrella quote. We'll contact you within 24 hours with competitive options.

Your Contact Information

So a licensed agent can reach you about this application. Not part of ACORD form 131.

Applicant / First Named Insured *

Phone *

Email *

1. ACORD Umbrella Section

Page 1 of the ACORD 131 — producer and policy header, underlying insurance schedule, and the coverage/exposure checklist.

TM ACORD UMBRELLA SECTION

DATE (MM/DD/YYYY)

PHONE (A/C, No, Ext):

FAX (A/C, No):

EFFECTIVE DATE

EXPIRATION DATE

PAYMENT PLAN

AUDIT

SUBCODE:

FOR COMPANY USE ONLY

EXPIRING POL

PROPOSED RETROACTIVE DATE

CURRENT RETROACTIVE DATE:

FIRST DOLLAR DEFENSE

YES

#_Row_1

NAME AND LOCATION OF PRIMARY AND ALL SUBSIDIARY COMPANIES (Describe Operations)_Row_1

ANNUAL PAYROLL_Row_1

ANN GROSS SALES_Row_1

FOREIGN GROSS SALES_Row_1

# EMPL_Row_1

CSL / BI EA. OCC. $

fill_81This box has no label in the source PDF; shown by its PDF field name.

CARRIER/POLICY NUMBER_AUTOMOBILE LIABILITY

POLICY EFF DATE_AUTOMOBILE LIABILITY

POLICY EXP DATE_AUTOMOBILE LIABILITY

BI EA. PER. $

fill_83This box has no label in the source PDF; shown by its PDF field name.

PD EA. ACC. $

fill_85This box has no label in the source PDF; shown by its PDF field name.

+ - RATING MOD_Row_1

EACH OCCURRENCE $

GENERAL AGGR $

PREM/OPS $

PROD & COMP OPS $ AGGREGATE

PERSONAL & ADV $ INJURY

PRODUCTS $

CARRIER/POLICY NUMBER_GENERAL LIABILITY POLICY TYPE OCCUR CLAIMS MADE

undefinedThis box has no label in the source PDF; shown by its PDF field name.

DAMAGE TO RENTED PREMISES $

MEDICAL EXPENSE $

OTHER $

+ - RATING MOD_Row_2

EACH ACCIDENT $

CARRIER/POLICY NUMBER_EMPLOYERS LIABILITY

POLICY EFF DATE_EMPLOYERS LIABILITY

POLICY EXP DATE_EMPLOYERS LIABILITY

undefined_2This box has no label in the source PDF; shown by its PDF field name.

+ - RATING MOD_$

EMPLOYERS LIABILITY_Row_1

CARRIER/POLICY NUMBER_Row_4

POLICY EFF DATE_Row_4

POLICY EXP DATE_Row_4

DISEASE $ POLICY LIMIT_Row_1

$_Row_1

+ - RATING MOD_Row_4

INDICATE THE EDITION DATE OF THE ISO SIMPLIFIED FORM OR SIMILAR FILING FOR THE UNDERLYING COVERAGE

WITHIN AGGREGATE LIMITS?

A SEPARATE LIMIT?

UNLIMITED?

HAS ANY PRODUCT, WORK, ACCIDENT, OR LOCATION BEEN EXCLUDED, UNINSURED OR SELF INSURED FROM ANY PREVIOUS COVERAGE?

YES

FOR CLAIMS MADE, INDICATE RETROACTIVE DATE OF CURRENT UNDERLYING POLICY:

FOR CLAIMS MADE, WAS "TAIL" COVERAGE PURCHASED FOR ANY PREVIOUS PRIMARY OR EXCESS POLICY

CHECK ALL COVERAGES IN UNDERLYING POLICIES. ALSO CHECK IF ANY EXPOSURES ARE PRESENT FOR EACH COVERAGE. PROVIDE AN EXPLANATION. EXPLAIN IF

YES, EFF. DATE:

COVERAGE EXPOSURE_ANY AUTO (SYMBOL 1) CGL - CLAIMS MADE CGL - OCCURRENCE

CARE, CUSTODY, CONTROL EMPLOYEE BENEFIT LIABILITY FOREIGN LIABILITY/TRAVEL GARAGEKEEPERS LIABILITY INCIDENTAL MEDICAL MALPRACTICE LIQUOR LIABILITY POLLUTION LIABILITY