Pest Control Insurance Quote Request

Pest Control Insurance Quote

Insurance for a Pest Control Operation can be complicated, out simple form allows us to rate your coverage request simply and easily to assist you in obtaining insurance for your Pest Control business.

"*" indicates required fields

We will process your request upon receipt.

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Name*

First Last

Business Entity is*

Full Legal Business Name or DBA*

Email*

Phone Number*

Fax Number

Alt Phone Number (cell, home)

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Website

Date Business Started*

Experience & Basic Rating Information

Address of your Operations

Street Address Address Line 2 City State ZIP Code

If same as your mailing address, indicate "SAME"

Please Briefly Describe the Nature of Your Business:*

Number of Owners*

Number of Full Time Field Employees (Including Owners)*

Number of Part Time Employees*

Does any of your operations include treating for BED BUGS?*

Yes

This includes your sub-contractor's operations.

Does any of your operations include HEAT TREATMENTS?*

Yes

This includes your sub-contractor's operations.

Does any of your operations include STRUCTURAL FUMIGATION?*

Yes

This includes your sub-contractor's operations.

Tasks Your Employees Perform

Primary Class*

Total Annual Gross Receipts From Primary Class*

Secondary Class

Total Annual Gross Receipts From Secondary Class

3rd Class

Total Annual Gross Receipts From 3rd Class

4th Class

Total Annual Gross Receipts From 4th Class

5th Class

Total Annual Gross Receipts From 5th Class

Total Annual Gross Receipts for Your Employees

How do you hire subcontractors?*

We Do Not Use Subs!

Usually Use Same Ones

Usually Put it Out to Bid

If you subcontract work, are certificates of insurance, with policy limits equal to, or greater than your own naming your company as additional insured always obtained*

Yes

Would you like coverage for Injuries to Your Subcontractors?*

Yes

Primary Subcontractor Class*

Total Receipts Subcontracted Class 1*

Secondary Class Subcontracted

Total Receipts Subcontracted Class 2

3rd Subcontractor Class

Total Receipts Subcontracted Class 3

4th Subcontractor Class

Total Receipts Subcontracted Class 4

5th Subcontractor Class

Total Receipts Subcontracted Class 5

Percent of Receipts from subcontracted work

Do you have a written safety program in place?*

Yes

Financial & Income Information

Do not enter $0 for payroll or revenue

Total Annual Payroll of Employees -Not Including Owners*

Total Annual Anticipated Gross Revenue*

Total Annual Cost of Sub-Contractors*

Operations & Experience Information

What percent of your work is performed in New York City*

How many Years of Experience do you have?:*

Are You Licensed?*

If so, what kind of license(s) do you hold?*

0 of 200 max characters

What is your license number?*

Who holds the license(s)*

Percent of work done INSIDE*

Percent of work done OUTSIDE*

% of Work Done as a General Contractor or GC*

A GC is one that subcontracts work.

% of Work Done as a Contractor*

A Contractors is one that is hired directly by the client

% of Work Done as a Subcontractor*

A Subcontractor is one that is hired directly by the GC

Percent of Work Done is RESIDENTIAL*

Percent of Work Done is COMMERCIAL*

Where are chemicals stored*

Bed Bug Operations

Do contracts include any warrantees or guarantees?*

Yes

If yes, describe any warrantees or guarantees provided*

Are disclaimers for Bodily Injury from insect bites included in all treatment contracts*

Yes

Are signed preparation checklists used for all bed bug treatment methods*

Yes

Trade names of pesticides used in bed bug treatments

Are structural fumigations performed for bed bugs*

Yes

List any other treatment methods performed that are not mentioned

If yes, trade names of fumigant(s) used

Are cryogenic/freeze treatments performed?*

Yes

Are bed bug inspections performed by canines*

Yes

If yes, are these inspections performed by an outside party or subcontractor*

Yes

Heat Treatments

Are dedicated employees used for heat treatments*

Yes

Years of experience of dedicated employees with heat treatment*

Brands and models of thermal equipment used*

Percent of Heat source treatments from Electric Equipment?

Percent of Heat source treatments from Propane Equipment?

Are sprinkler systems deactivated during treatments*

What systems/equipment is used for thermal protection of sprinkler heads?*

What is the maximum temperature allowed in the thermal boot during treatment*

What is the maximum air temperature allowed in treatment spaces*

Are continuous, remote temperature monitoring used during treatments*

Yes

Are signed preparation checklists used for heat treatments*

Yes

Heat treatments performed at...*

Single family dwellings

Multifamily dwellings

Hotels/resorts

Offices/commercial buildings/retail businesses

Transportation/trains/buses/aircraft

Homeless shelters/halfway houses/group homes

Other (Specify Below)

Check all that apply

Other heat treatment facilities.*

% of time that Sulfuryl Fluoride used in your Fumigation operations (ex., Vikane)*

Enter 0 if not used

% of time that Methyl Bromide used in your Fumigation operations*

Enter 0 if not used

Has your product stewardship certification ever lapsed or been revoked*

Yes

Has your gas detection equipment ever failed calibration certification or been out of compliance with product stewardship guidelines or regulatory requirements*

Yes

Underwriting & Procedural Information

3. Any work performed below grade?*

Yes

If so what is the Maximum Depth*

0 of 3 max characters

What is the % of your total work below grade?*

0 of 3 max characters

Do you use scaffolding for your operations?*

Yes

Is it owned or rented?*

Are other contractors at the site allowed to use it?*

Yes

Any other operations outside the realm of "Pest Control"?*

Yes

If so please explain*

We have formal written and documented training programs for the following*

Housekeeping/Security of pesticide storage areas

Pesticide labels, mixing and application

Driver safety training

None of the above

We have spill kits for the following*

Storage Area

All Service Vehicles

None of the above

Do you "private label" any chemicals for sale to customers*

Yes

Have you had any "alleged" poisoning complaints within the last 36 months?*

Yes

Have you been cited for any governmental violations within the last 36 months*

Yes

Provide details*

Do you hold any licenses/certifications other than pest control that generate receipts*

Yes

WDO, Termites, Inspections & Wildlife

Do you perform inspections and treatments of structures equipped with sprinkler systems*

Yes

Do you identify water shut off valves prior to attic entry*

Yes

Do you train on identifying attic sprinkler and water pipe locations*

Yes

Describe your emergency procedures for mitigating water damage from pipe break*

Do you perform WDO Reports for Real Estate inspections*

Yes

Do you perform WDO real estate inspections and treat structures with Exterior Insulation Finishing System (EIFS) construction*

Yes

What is the average time spent on each WDO inspection, in minutes*

Approximately how many WDO inspections are performed each year?*

Do you perform Subterranean Termite Control work*

Yes

Will you assume a termite renewal contract on structures that you have not originally treated*

Yes

What is the average cost per WDO inspection*

Do you perform any Wildlife Control/Removal work*

Yes

Are any firearms used*

Yes

Is any animal damage repair work performed*

Yes

What is your release/disposal/euthanize policy*

Loss Information

Any losses or claims in the last 5 Years?*

Yes

Current Insurance Information

Are you currently insured*

What is the name of your current insurance carrier?*

0 of 50 max characters

Current insurance expiration date*

Current annual insurance premium*

How long have you been continuously insured?

Coverage Information

Liability Coverage Requested*

$300,000

$600,000

$1,000,000

$2,000,000

This provides coverage for bodily injury and property damage

Property Damage Deductible Requested*

Umbrella/Excess Liability Coverage*

Do you currently have Workers Comp coverage?*

Yes

Do you currently have Disability Insurance coverage?*

Yes

Finance Information

Ever filed Bankruptcy or Reorganization*

Yes

Has coverage been Declined, canceled or non-renewed in last 5 years

Yes

If so, why?

Final Details

How soon do you need this quote*

Date quote needed by

MM slash DD slash YYYY

What date do you need this coverage by?*

MM slash DD slash YYYY

How did you hear about us?

If you were referred, who can we thank with a nice gift?

What other coverages are you interested in?*

None

Workers Comp

Disability

Group Health

Employment Practices Liability

Business Property / Tools

Business Income Coverage

What is your total annual Pest Control Application payroll?*

What is your total annual clerical payroll?*

What is your copmpany's Federal Tax ID #*

Required for Workers Comp & Disability

How many male employees do you have?

0 of 3 max characters

How many female employees do you have?

0 of 3 max characters

Business Property

This provides coverage for your possessions your business owns. (desks, chairs, tables, books...)

Please enter a number from 0 to 10000000.

Property Deductible

What deductible would you prefer for the property coverage? Higher deductibles have lower insurance costs.

Business Income Coverage Requested

This provides monetary coverage in the event your business is closed because of a covered loss (fire, storm, smoke damage)

Please enter a number from 0 to 10000000.

If you are a new business please upload a copy of your resume. If you are currently or was previously insured, please upload a copy of 3 years currently valued loss runs.

Drop files here or

Accepted file types: jpg, gif, png, pdf, tif, Max. file size: 8 MB, Max. files: 10.

Please feel free to attach any files that might be useful in rating your coverages... Prior or current policies, loss runs, claims, photos of cool bugs you've killed, pictures your kids drew in kindergarten...

Other things I want to tell you that you didn't ask. Additional comments, concerns, circumstances, or coverages you have/want.

0 of 500 max characters

Comments

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