Umbrella Insurance Policy Application - Alliance for Contractors

UMBRELLA INSURANCE POLICY APPLICATION

Comprehensive Excess Liability Protection

This application provides access to umbrella insurance coverage offering additional liability protection above your primary insurance policies. Our Alliance integration ensures optimal coverage coordination, automated gap identification, and premium optimization for maximum protection and cost efficiency.

1. APPLICANT INFORMATION

Legal Name (Individual/Business):

DBA/Trade Name:

Primary Contact:

Title:

Business Address:

City:

State:

ZIP Code:

Phone:

Email:

Federal Tax ID:

Years in Business:

Business Type:

2. CURRENT INSURANCE COVERAGE ASSESSMENT

Coverage Type	Insurance Carrier	Policy Number	Effective Date	Expiration Date	Limit Per Occurrence	Aggregate Limit
General Liability
Commercial Auto
Professional Liability
Workers' Compensation

3. UMBRELLA COVERAGE LIMITS SELECTION

Requested Umbrella Coverage Limit:

$1,000,000

$2,000,000

$5,000,000

$10,000,000

Other: $

Primary Use Cases (Select all that apply):

Large Project Protection

High-Value Client Requirements

Personal/Business Asset Protection

Catastrophic Loss Coverage

Comprehensive Risk Management

4. RISK ASSESSMENT QUESTIONNAIRE

Annual Gross Revenue:

Number of Employees:

Primary Business Operations:

Geographic Service Area:

Local (within 50 miles)

Regional (statewide)

National

International

Risk Level Assessment:

Low Risk Moderate Risk High Risk

5. PROPERTY AND ASSET INFORMATION

Real Estate Owned (Estimated Value):

Business Personal Property (Estimated Value):

Fleet/Equipment Value:

Other Significant Assets:

Largest Single Project Value (Last 3 Years):

6. CLAIMS HISTORY

Have you had any liability claims in the past 5 years?

Yes

If yes, please provide details (Date, Type, Amount):

Any pending or threatened claims?

Yes

7. PREMIUM CALCULATION FRAMEWORK

Estimated Annual Premium Range

$_____ - $_____

Final premium subject to underwriting review and Alliance optimization analysis

Premium Factors	Rating Basis	Impact
Coverage Limit	Selected limit amount	High
Underlying Coverage	Primary policy limits	High
Business Type/Risk	Industry classification	High
Revenue/Exposure	Annual gross revenue	Medium
Claims History	Past 5-year experience	Medium
Geographic Territory	Service area scope	Low

      Alliance Integration Benefits
      
          Automated Coverage Gap Identification - AI-powered analysis identifies potential coverage gaps in your current
          insurance portfolio
        
          Premium Optimization Strategies - Advanced algorithms recommend optimal coverage limits and deductibles for
          cost efficiency
        
Portfolio Coordination Analysis - Ensures seamless integration between umbrella and underlying policies

          Real-time Risk Assessment - Continuous monitoring of risk factors with proactive adjustment recommendations
        
Claims Management Integration - Streamlined claims process across all coverage layers
Annual Coverage Reviews - Automated analysis ensures coverage keeps pace with business growth
Competitive Market Analysis - Regular comparison against market alternatives to ensure best value

8. ALLIANCE RISK MANAGEMENT SERVICES

Areas of Interest for Risk Management Support:

Safety Training Programs

Contract Review Services

Regulatory Compliance Monitoring

Loss Control Inspections

Incident Management Protocols

9. SUBMISSION REQUIREMENTS

Required Documentation (Check when attached):

Current Insurance Policy Declarations Pages

5-Year Loss Runs from Current Carriers

Recent Financial Statements

Business License/Certificates

Major Project Schedule (if applicable)

10. APPLICANT DECLARATION AND SIGNATURE

I hereby declare that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that this application does not bind coverage and that all coverage is subject to underwriting approval and policy terms and conditions. I authorize Alliance for Contractors to verify any information provided and to obtain additional information as needed for underwriting purposes.

I agree to the terms and conditions stated above and authorize Alliance for Contractors to process this application.

Applicant Signature:

Date:

Print Name:

Title:

Next Steps

Upon submission, your application will be processed through our Alliance Risk Management platform:

Automated preliminary risk assessment within 24 hours
Coverage gap analysis and optimization recommendations
Underwriting review and premium calculation
Policy structure recommendations for maximum protection
Final proposal presentation with implementation timeline

Questions? Contact your Alliance for Contractors representative or call our Umbrella Insurance specialists at 1-800-ALLIANCE

Alliance for Contractors - Professional Insurance Solutions & Risk Management
Application Form UM-2024 | For Office Use: App# _____ Date Received: _____ Agent: _____

ALLIANCE FOR CONTRACTORS

UMBRELLA INSURANCE POLICY APPLICATION

Comprehensive Excess Liability Protection

Alliance Integration Benefits

Next Steps