Form 79: General Liability Insurance Application
FORM 79

General Liability Insurance Application

Professional Coverage Solutions for Alliance Members

1. APPLICANT INFORMATION
Enter your Alliance membership number for preferred rates
2. BUSINESS OPERATIONS
Carpentry
Drywall
Insulation
Siding
Windows/Doors
Tile/Stone
Excavation
Fencing
🏆 ALLIANCE MEMBER EXCLUSIVE BENEFITS
Up to 15% savings through group purchasing power
Integrated risk management tools and resources
Priority claims handling and support
Automated renewal reminders and optimization
Safety training programs and certification
Coverage expansion recommendations based on growth
3. COVERAGE REQUIREMENTS
Coverage Type Requested Limit Deductible Required
General Liability - Per Occurrence Yes
General Liability - Aggregate Same as above Yes
Products/Completed Operations Same as above Yes
Personal & Advertising Injury Same as above Recommended
Contractual Liability
Additional Insured Coverage
Waiver of Subrogation
Broad Form Property Damage
4. RISK ASSESSMENT QUESTIONNAIRE
Do you have a formal written safety program?
Do you conduct regular safety meetings?
Do you require safety training for all employees?
Have you had any claims in the past 5 years?
Do you verify insurance coverage for all subcontractors?
Do you work at heights over 15 feet?
5. PROJECT INFORMATION
New Construction
Renovation/Remodeling
Repair Work
Maintenance
Emergency Services
Specialty Work
6. ADDITIONAL COVERAGE OPTIONS
Commercial Auto Liability
Workers' Compensation
Professional Liability
Cyber Liability
Umbrella/Excess Liability
Tools & Equipment Coverage
Surety Bonds
Employment Practices Liability
7. ADDITIONAL INFORMATION

APPLICANT CERTIFICATION AND SIGNATURE

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

I understand that:

  • This application does not bind coverage until accepted by the insurance company
  • Coverage is subject to policy terms, conditions, and exclusions
  • Alliance member benefits are available to active members in good standing
  • Premium quotes are estimates and subject to underwriter approval

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MM/DD/YYYY

Ready to Submit Your Application?

Next Steps:

1. Review all information for accuracy and completeness

2. Sign and date the application

3. Submit to your Alliance insurance representative

4. Expect a response within 2-3 business days

Questions? Contact Alliance Insurance Services:
Phone: 1-800-ALLIANCE | Email: [email protected]