Insurance Application — Contractor, Workers' Comp, Restaurant, Home & Auto

Contractor / General Liability

Four steps. This is a real application — complete answers mean a real quote instead of a range.

Step 1 — About the business

Licensed contractors: enter your license number and we'll pull your business details ourselves — fewer fields for you to fill in.

Contractor license # (if you have one)

Licensed in (if you gave a license number)

Legal business name *

DBA / trade name (if different)

Entity type *

Federal EIN (business tax ID)

EIN only — never enter a Social Security number. We need your EIN to finalize a commercial quote. No EIN yet (sole proprietor)? Leave it blank and we'll sort it out before binding.

Contact first name *

Contact last name *

Email *

Phone *

Preferred contact *

Business address *

State *

Years in business *

Website (if any)

Desired start date

Step 2 — The work you do

Primary trade *

Percent residential vs commercial *

Describe the work you actually do *

Do you work at heights over 3 stories? *

Any roofing, excavation, or demolition? *

Largest single job in the past year *

Gross receipts, last 12 months *

Estimated gross receipts, next 12 months *

Annual payroll (excluding owners) *

Number of employees *

Do you use subcontractors? *

Do your subs carry their own insurance? (required if you use subs)

Uninsured subcontractors are usually charged as your payroll at audit. Collecting a certificate from every sub keeps your premium honest.

Step 3 — Coverage needed

What do you need quoted? *

General liability Workers' compensation Commercial auto Tools & equipment Umbrella Builders risk

General liability limits needed *

Tools & equipment value to insure

Does a contract require specific limits or additional insured status? *

Paste the contract's insurance language (required if yes — paste it exactly)

Do you use vehicles for the business? *

Do you have a USDOT number? *

USDOT number (required if yes — saves you filling in the vehicles)

Vehicles — year, make, model, VIN (if no USDOT number)

Step 4 — Insurance history

Insured today? *

Current carrier (required if insured)

Renewal / expiration date (required if insured)

Years continuously insured

Any claims or losses in the last 5 years? *

Ever been cancelled or non-renewed? *

If yes to either — or if something appears on carrier loss reports — we'll follow up in writing. Neither stops us from quoting.

Anything else we should know

By submitting this form, you authorize City Insurance Plus LLC, City Insurance & Financial Services Inc, and their partner carriers to obtain consumer reports as permitted by law. These may include motor vehicle records (MVR), credit-based insurance scores, and prior claims history (CLUE). Submission of this form does not guarantee coverage. Quotes are subject to underwriting approval, and coverage is not effective until confirmed in writing by the carrier. City Insurance Plus LLC and City Insurance & Financial Services Inc are not responsible for underwriting decisions made by carriers.

Step 1 of 4

Never enter Social Security numbers or payment details on this site. Submitting does not bind coverage.

Workers' Compensation

Three steps. Workers' comp is priced on payroll and job classification — the more accurate this is, the closer the quote.

Step 1 — About the business

Licensed contractors: enter your license number and we'll pull your business details ourselves.

Contractor license # (if you have one)

Licensed in (if you gave a license number)

Legal business name *

DBA / trade name

Entity type *

Federal EIN (business tax ID)

EIN only — never enter a Social Security number. We need your EIN to finalize a commercial quote. No EIN yet (sole proprietor)? Leave it blank and we'll sort it out before binding.

Contact first name *

Contact last name *

Email *

Phone *

Preferred contact *

Business address *

States where employees work *

Years in business *

Desired start date

Step 2 — Payroll & operations

Describe your operations *

Full-time employees *

Part-time or seasonal employees *

Annual payroll by job type *

Owners / officers — include or exclude? *

Do you use subcontractors? *

Do your subs carry their own workers' comp? (required if you use subs)

Any work at heights, confined spaces, or other hazardous operations?

Step 3 — History & coverage

Do you have workers' comp today? *

Current carrier (required if insured)

Renewal / expiration date (required if insured)

Experience modifier (if you know it)

Any workers' comp claims in the last 5 years? *

Ever cancelled or non-renewed for workers' comp? *

If yes to either, we'll follow up in writing. Neither stops us from quoting.

Anything else we should know

Step 1 of 3

Never enter Social Security numbers or payment details on this site. Submitting does not bind coverage.

Restaurant, Bar & Food Service

Four steps. Food businesses need several coverages working together — this covers the whole stack.

Step 1 — About the business

Legal business name *

DBA / restaurant name *

Entity type *

Federal EIN (business tax ID)

EIN only — never enter a Social Security number. We need your EIN to finalize a commercial quote. No EIN yet (sole proprietor)? Leave it blank and we'll sort it out before binding.

Contact first name *

Contact last name *

Email *

Phone *

Preferred contact *

Location address *

State *

Years in business / under current ownership *

Desired start date

Step 2 — The operation

Type of operation *

Seating capacity *

Square footage *

Closing time on your latest night *

Annual food sales *

Annual alcohol sales *

Do you serve alcohol? *

Server alcohol training? (required if you serve)

Deep fryer or open-flame cooking? *

Hood & duct fire suppression system? *

Live entertainment or dancing? *

Delivery or catering off-site? *

Step 3 — Property & staff

Building owned or leased? *

Does your lease require specific limits or additional insured? (required if leased)

Building value (if you own it)

Equipment & contents value *

Tenant improvements value (your build-out)

Sprinkler system? *

Burglar / fire alarm? *

Number of employees *

Annual payroll *

Paste your lease's insurance language (if it requires specific coverage)

Step 4 — Coverage & history

Step 1 of 4

Never enter Social Security numbers or payment details on this site. Submitting does not bind coverage.

Other Business Insurance

Three steps. Retail, office, service, trucking — if it isn't contracting, restaurant, or rental property, start here.

Step 1 — About the business

Legal business name *

DBA / trade name

Entity type *

Federal EIN (business tax ID)

EIN only — never enter a Social Security number. We need your EIN to finalize a commercial quote. No EIN yet (sole proprietor)? Leave it blank and we'll sort it out before binding.

Contact first name *

Contact last name *

Email *

Phone *

Preferred contact *

Business address *

State *

Years in business *

Website (if any)

Desired start date

Step 2 — Operations

Industry *

Where do you operate from? *

Describe what the business actually does *

Does your lease require specific insurance? (required if leased)

Annual gross receipts *

Annual payroll *

Number of employees *

Equipment & contents value *

Do you use vehicles for the business? *

Do you have a USDOT number? *

USDOT number (required if yes — saves you filling in the vehicles)

Vehicles — year, make, model, VIN (if no USDOT number)

Paste your lease's insurance language (if it requires specific coverage)

Step 3 — Coverage & history

Step 1 of 3

Never enter Social Security numbers or payment details on this site. Submitting does not bind coverage.

Landlord / Rental Property

Four short steps. This is a real application — complete answers mean a real quote with no back-and-forth.

Step 1 — About you

First name *

Last name *

Date of birth *

Email *

Mobile * (carriers require a phone on file)

Preferred contact *

State *

Desired start date

Step 2 — The property

Property address *

Year built *

Property type *

Construction *

Square footage *

Stories *

Roof type *

Roof year replaced *

Occupancy *

Monthly rent *

Exact name on the title / deed *

Step 3 — Systems & safety

Electrical panel *

Electrical — year updated *

Plumbing — year updated *

Heating type *

Heating — year installed *

Smoke detectors? *

Dog on premises? Breed?

Pool or trampoline?

Step 4 — Insurance history & coverage

Is the property insured today? *

Current carrier (required if insured)

Renewal / expiration date (required if insured)

Any claims or losses in the last 5 years? *

If yes — or if claims appear on carrier loss reports — we'll follow up in writing for the details. Claims don't stop us from quoting.

Desired dwelling coverage

Liability limit

Deductible preference

Mortgage / lienholder (if any)

Anything else we should know

Step 1 of 4

Never enter Social Security numbers or payment details on this site. Submitting does not bind coverage — no policy is in force until confirmed in writing.

Home Insurance

Four short steps. Complete answers mean a real quote with no back-and-forth.

Step 1 — About you

First name *

Last name *

Date of birth *

Email *

Mobile * (carriers require a phone on file)

Preferred contact *

State *

Desired start date

Co-applicant (spouse/partner — name and date of birth)

Step 2 — The home

Address *

Year built *

Construction *

Square footage *

Stories *

Roof type *

Roof year replaced *

Garage *

Occupancy *

Step 3 — Systems & safety

Electrical panel *

Electrical — year updated *

Plumbing — year updated *

Heating type *

Heating — year installed *

Alarm system? *

Dog? Breed?

Pool or trampoline?

Step 4 — Insurance history & coverage

Is the home insured today? *

Current carrier (required if insured)

Renewal / expiration date (required if insured)

Years continuously insured

Any claims in the last 5 years? *

If yes — or if claims appear on carrier loss reports — we'll follow up in writing for the details. Claims don't stop us from quoting.

Deductible preference

Mortgage / lienholder (if any)

Anything else we should know

Step 1 of 4

Never enter Social Security numbers or payment details on this site. Submitting does not bind coverage — no policy is in force until confirmed in writing.

Auto Insurance

Four short steps. Driver's license photos are uploaded here — it's how we keep the quotes real. VINs are required: no VIN, no quote.

Step 1 — About you

First name *

Last name *

Date of birth *

Email *

Mobile * (carriers require a phone on file)

Preferred contact *

Home / garaging address * (where you live and the vehicles sleep — must be Arkansas or Minnesota)

License state / country *

Desired start date

Step 2 — Drivers & licenses

You are Driver 1 — upload a clear photo or scan of your license (front). Add every licensed driver in the household; if you start a driver's row, complete it.

Driver 1 — your driver's license photo *

Driver 2 — first name

Driver 2 — last name

Driver 2 — date of birth

Driver 2 — license photo

Driver 3 — first name

Driver 3 — last name

Driver 3 — date of birth

Driver 3 — license photo

Any accidents, tickets, or violations — any driver, last 5 years? *

If yes — or if anything appears on motor vehicle reports — we'll follow up in writing for the details. Violations don't stop us from quoting.

Step 3 — The vehicles

VIN is required for every vehicle — it's how we guarantee the price we send you is real. If you start a vehicle's row, complete it.

Vehicle 1 — year *

Vehicle 1 — make & model *

Vehicle 1 — VIN *

Vehicle 1 — owned / financed / leased *

Vehicle 1 — annual miles *

Vehicle 1 — use *

Vehicle 2 — year

Vehicle 2 — make & model

Vehicle 2 — VIN

Vehicle 2 — owned / financed / leased

Vehicle 2 — annual miles

Vehicle 2 — use

Vehicle 3 — year

Vehicle 3 — make & model

Vehicle 3 — VIN

Vehicle 3 — owned / financed / leased

Vehicle 3 — annual miles

Vehicle 3 — use

Step 4 — Insurance history & coverage

Insured today? *

Current carrier (required if insured)

Renewal / expiration date (required if insured)

What do you want? *

We quote liability limits of 100/300/100 or better — we don't write state-minimum liability limits. Uninsured/underinsured motorist coverage is included in what we quote, and we quote a $0 glass deductible where it's available.

Anything else we should know

Step 1 of 4

Never enter Social Security numbers or payment details on this site. License photos are used only for quoting. Submitting does not bind coverage — no policy is in force until confirmed in writing.

Renters Insurance

Three short steps — renters is the quick one.

Step 1 — About you

First name *

Last name *

Date of birth *

Email *

Mobile * (carriers require a phone on file)

Preferred contact *

State *

Step 2 — The rental

Address & unit *

Building type *

Dog? Breed?

Desired start date

Step 3 — Insurance history & coverage

Do you have renters insurance today? *

Current carrier (required if insured)

Any claims in the last 5 years? *

If yes, we'll follow up in writing for the details. Claims don't stop us from quoting.

Personal property coverage

Liability

Anything else (landlord requires a certificate? valuables?)

Step 1 of 3

Never enter Social Security numbers or payment details on this site. Submitting does not bind coverage — no policy is in force until confirmed in writing.

Complete a full application.

Contractor / General Liability

Workers' Compensation

Restaurant, Bar & Food Service

Other Business Insurance

Landlord / Rental Property

Home Insurance

Auto Insurance

Renters Insurance