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New York Contractor Insurance Application

This is the same information carriers ask for on the ACORD 125/126 and the New York contractor supplement. Complete it once — we take it to every market that fits your operations.

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NY-licensed broker · DFS BR-1969329
E&S, wholesale & London market access
English · Español · Português

Quick answer

Fill out this application, then email your dec page, 5 years of loss runs and your contract's insurance requirements to adolfo@nextguardinsurance.com. With a complete file, most New York contractor GL quotes come back in about 2 to 5 business days. Fields marked * are required; if you don't know an exact number, give your best estimate and say so.

Speed up your quote — email these first

The fastest way to get quoted is email. Send to adolfo@nextguardinsurance.com:

Current policy declarations page (dec page), if insured
Loss runs for the last 5 years (3 minimum)
The insurance requirements from your contract or the COI request from your GC / building
Your subcontractor agreement and a sample sub COI (if you use subs)
Last year's gross receipts and payroll, and a short description of your work

1. Business information

Legal business name *

DBA (if any)

Entity type *

FEIN (optional)

Business address *

Years in business *

Borough / county of most work *

Website

NYC DOB license or registration # (if any)

DCWP Home Improvement license # (if any)

Contact name *

Phone *

Email *

2. Operations

Trade / class *

Maximum height you work at (stories) *

Describe exactly what you do (types of jobs, typical job size) *

% residential

% commercial

% new construction (vs. remodel/repair)

% exterior work

Any roofing work? *

Hot work (torch, welding, brazing)? *

Underpinning, excavation or structural work? *

Do you erect scaffolds or sidewalk sheds? *

Gas, boiler, solar, EV or battery work? Describe

Work outside New York?

3. Receipts, payroll & subcontractors

Gross receipts — last 12 months ($) *

Estimated receipts — next 12 months ($)

Owner(s) payroll ($)

Employee payroll ($)

Number of employees *

Paid to subcontractors — last 12 months ($) *

Do your subs carry GL naming you as additional insured? *

Written hold-harmless agreement with subs?

Largest single job in last 3 years ($)

4. Insurance & claims history

Currently insured? *

Current insurance company

Current policy expiration

Current annual premium ($)

Number of claims in last 5 years *

Cancelled or non-renewed in last 3 years? Why?

Describe any claims (date, what happened, amount paid)

5. Coverage you need

GL limits needed *

Umbrella / excess limit needed

Need workers' comp + disability/PFL?

Need builders risk?

Commercial vehicles (number and type)

Tools & equipment value ($)

Coverage start date needed *

Paste your contract's insurance requirements (or the GC / building COI request)

Certificate holders & additional insureds needed

6. Confirmation

Name of person completing *

Title

I confirm this information is accurate to the best of my knowledge *

One submission, done right — don't call 10 agencies

In NY contractor GL, wholesalers and carriers usually work the account with the first broker who submits it. If five agencies send your name to the same markets, those markets get blocked and your quote slows down or dies. Send us one complete submission — we take it to every market that fits and show you the options side by side.

Frequently asked questions

What documents do I need besides this form?

Your current dec page (if insured), 5 years of loss runs (3 minimum), your contract's insurance requirements and, if you use subs, your subcontract agreement and a sample sub certificate.

Is my information shared with every insurance company?

No. We only submit to markets that fit your operations, and only once — which protects your file and speeds up quoting.

Can I fill this out in Spanish?

Yes — use the Spanish version of this application.

Location

3000 S Ocean Drive

Hollywood, Fl. 33019

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