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Contractor's Quote Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

General Information
Company Name
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First Name
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Last Name
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Street
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City
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State
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ZIP / Postal Code
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Primary Phone Number
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Fax Number
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E-Mail Address
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Best Way to Contact You
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Tell Us About Your Business
What type of work do you do?
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This business is
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Do you conduct operations outside of Michigan?
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Percentage of work that is residential
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Percentage of work that is commercial
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Number of Owners
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Number of Employees OTHER than Owners
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Estimated Annual Payroll (Excluding Owners)
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Annual Cost of Subcontractors
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Gross Annual Sales
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Liability Insurance
Expiration Date
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/ /
What coverage limits would you like quoted?
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How many additional insureds are required?
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Property Insurance
Replacement Cost of Building (if you own)
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Replacement Cost of Business Contents
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Value of Small Tools & Equipment
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Value of Self-Propelled Contractor's Equipment
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Value of Materials at Work Site
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Commercial Auto
Number of Vehicles Owned / Leased by your business
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Workers Compensation
Expiration Date
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/ /
FEIN or Social Security if Sole Proprietorship
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How did you hear about us?
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Comments or additional information about your business?
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Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages.  Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company.  If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
HAPPY 4th of JULY!

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Lighthouse Group Main Office in Grand Rapids, MI
Mailing Address | P.O. Box 530009, Livonia, MI 48153

Phone: 734.421.9900 | Toll Free: 800.220.5582 | Fax: 734.421.9911

Also serving these Detroit area communities in Michigan: Livonia, Farmington Hills, Ann Arbor, Southfield, Plymouth, Canton, Westland, Northville, Novi, Dearborn, South Lyon & Walled Lake