Directors & Officers Insurance Application - Alliance for Contractors

Directors & Officers Insurance Application

Leadership Liability Protection for Incorporated Contracting Businesses

Protect Your Leadership, Secure Your Future

As an incorporated contracting business, your leadership team faces unique exposures that can threaten both personal assets and business continuity. Directors & Officers (D&O) insurance provides essential protection against claims alleging wrongful acts in managing your company, including employment practices violations, regulatory investigations, and fiduciary breaches.

This comprehensive application process ensures you receive coverage tailored to the specific risks facing modern contracting enterprises. Complete all sections thoroughly to enable our underwriters to provide the most competitive terms for your leadership liability protection.

Section 1: Company Information

Legal Company Name:

DBA/Trade Names:

State of Incorporation:

Date of Incorporation:

Primary Business Address:

City:

State/ZIP:

Federal Tax ID Number:

Website URL:

Section 2: Leadership & Management Details

Total Number of Directors:

Total Number of Officers:

Total Number of Employees:

Key Leadership Information

Please provide details for all directors and officers (attach additional sheets if necessary)

CEO/President Name & Experience:

CFO/Financial Officer Name & Experience:

Other Key Officers/Directors:

Section 3: Business Operations & Revenue

Primary Contracting Specialties:

☐ Commercial Construction

☐ Residential Construction

☐ Heavy Civil/Infrastructure

☐ Electrical Contracting

☐ HVAC Systems

☐ Plumbing

☐ Specialty Trades

☐ Other: ________________

Geographic Service Area:

Financial Information (Last 3 Years)

Current Year Projected Revenue:

Prior Year Revenue:

Two Years Ago Revenue:

Three Years Ago Revenue:

Largest Single Project Value (Current):

Percentage of Revenue from Top 3 Clients:

Section 4: Claims History & Legal Matters

Has your company or any director/officer been subject to any of the following in the past 5 years?

☐ Employment practices claims or lawsuits

☐ Regulatory investigations or enforcement actions

☐ Shareholder or partnership disputes

☐ Fiduciary liability claims

☐ Professional liability claims

☐ Criminal charges or investigations

☐ Bankruptcy or insolvency proceedings

☐ None of the above

If any boxes checked above, provide detailed explanation:

Are you aware of any circumstances that could reasonably result in a D&O claim?

☐ Yes ☐ No

If yes, provide details:

Section 5: Risk Management & Corporate Governance

Current Risk Management Practices:

☐ Written employment policies and procedures

☐ Regular board meetings with documented minutes

☐ Annual financial audits by independent CPA

☐ Formal compliance training programs

☐ Legal counsel retained for significant decisions

☐ Background checks for key personnel

☐ Whistleblower/ethics hotline

☐ Cybersecurity policies and training

Board Meeting Frequency:

☐ Monthly ☐ Quarterly ☐ Semi-Annually ☐ Annually ☐ As Needed

Do you maintain comprehensive written corporate bylaws?

☐ Yes ☐ No

Employee Handbook Last Updated:

Section 6: Coverage Requirements

Desired Coverage Limit:

☐ $1,000,000 ☐ $2,000,000 ☐ $5,000,000 ☐ $10,000,000 ☐ Other: $____________

Preferred Deductible:

☐ $0 ☐ $2,500 ☐ $5,000 ☐ $10,000 ☐ $25,000 ☐ Other: $____________

Additional Coverage Needs:

☐ Employment Practices Liability (EPL)

☐ Fiduciary Liability

☐ Crime/Employee Dishonesty

☐ Cyber Liability

☐ Entity Coverage

Current or Prior D&O Insurance Carrier:

Reason for Changing Coverage (if applicable):

Alliance for Contractors Exclusive Benefits

As an Alliance member, your D&O insurance includes premium value-added services:

Corporate Governance Training: Quarterly workshops on best practices for board oversight, fiduciary duties, and regulatory compliance specific to contracting businesses
Risk Management Resources: Access to employment law updates, safety compliance guides, and crisis management protocols
Legal Helpline: 24/7 access to employment law attorneys for immediate guidance on emerging issues
Claims Prevention Tools: Pre-claim consultation services and document review for high-risk decisions
Preferred Pricing: Group rates negotiated exclusively for Alliance members, typically 15-25% below market

Section 7: Additional Information

Special Circumstances or Additional Information:

Preferred Insurance Agent/Broker (if any):

Desired Policy Effective Date:

Authorization & Signature

I hereby authorize Alliance for Contractors and its insurance partners to investigate any information provided in this application. I certify that the information provided is true, complete, and accurate to the best of my knowledge. I understand that any material misrepresentation may void coverage.

Signature:

Date:

Printed Name & Title:

Ready to Secure Your Leadership Protection?

Submit your completed application to begin the underwriting process. Our insurance specialists will review your submission and provide a comprehensive quote within 48 hours.

Submit Application To:

Alliance for Contractors Insurance Division

Email: [email protected]

Phone: 1-800-ALLIANCE (1-800-255-4262)

Secure Portal: members.allianceforcontractors.com/insurance

Questions? Schedule a consultation with our D&O specialists.

Alliance for Contractors | Building Excellence Through Strategic Partnerships

This application is for insurance placement purposes only and does not constitute a contract of insurance.

ALLIANCE FOR CONTRACTORS