Can this form be e-signed?

Yes. Electronic signatures meeting the ESIGN Act (15 U.S.C. ch. 96) and state UETA requirements are valid if intent, consent, attribution, and record retention are documented.

Is notarization sometimes required?

Notarization is rarely required for the exposure form itself but may be needed for attached affidavits, waivers, or recorded documents depending on state law and instrument type.

What if a signer’s name differs from corporate records?

Mismatched names can delay acceptance. Provide corporate authorization or a resolution showing delegated signing authority to verify attribution.

Do I need to attach loss runs?

Yes. Underwriters commonly require loss runs for the past five years; include dates, amounts paid, and open/closed status to avoid follow-up requests.

How do remote notary sessions affect submission?

If a document requires notarization, use an approved RON provider where permitted; follow the state's identity proofing and audio-video retention rules.

What retention rules apply to signed forms?

Retain signed exposure forms per IRS and industry rules (typically at least three to seven years) and longer for HIPAA, SEC, or state-specific mandates.

Electronic Signature
Templates
Insurance
Insurance Contractor Exposure Form

Insurance Contractor Exposure Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

INSURANCE CONTRACTOR EXPOSURE FORM

Applicant / Insured Information

Insured Name Doing Business As (DBA)

Federal Tax ID / SSN:

State of Incorporation / Registration:

Entity Type (check all that apply) Individual Corporation LLC Partnership Other

Principal Business Address

Contact Name:

Phone:

Email:

Policy Information Requested

Policy Type Requested: General Liability Workers' Compensation Commercial Auto Excess / Umbrella

Desired Effective Date:

Coverage Limit Requested:

Deductible:

Operations and Activities

Detailed Description of Operations, Typical Jobs, and Work Performed

Primary trade classification / NAICS or SIC (if known):

Work Locations (list primary project locations and any out-of-state operations)

Payroll, Receipts, and Exposure Bases

Total Annual Payroll:

Total Annual Receipts / Gross Sales:

Estimated Annual Subcontractor Costs:

Employees, Subcontractors and Labor Practices

Number of Officers / Owners:

Number of Employees (full-time):

Number of Part-time / Seasonal:

Do you use subcontractors? Yes No

If yes, approximate percentage of work performed by subcontractors: %

Do you require Certificates of Insurance from subcontractors? Yes No

Equipment, Vehicles and Property Exposures

Major Equipment and Values (list owned and leased heavy equipment, cranes, scaffolding)

Number of Company Vehicles:

Safety Programs and Risk Management

Do you have a written safety program? Yes No

Describe safety, training and inspection procedures (including frequency)

Drug / alcohol testing program? Yes No

Claims and Loss History (Last 5 Years)

Complete the table below. If none, write "None" in the first row description.

Claim 1 — Date of Loss:

Description:

Paid / Reserved Amount:

Claim 2 — Date of Loss:

Description:

Paid / Reserved Amount:

Claim 3 — Date of Loss:

Description:

Paid / Reserved Amount:

Exposures, Exclusions and Additional Information

Known exposures or operations that may be excluded or require special underwriting (check any that apply):

Pollution / Environmental operations Asbestos abatement Demolition / structural alteration Trenching / excavation greater than 5 ft Professional services / design work Provide details of any exposures checked above or other material facts

Certificates, Additional Insureds and Loss Payees / Beneficiaries

Add Additional Insured / Certificate Holder Loss Payee / Beneficiary Information (if applicable)

Relationship:

Share Percentage: %

Declarations, Representations and Authorization

The undersigned declares that the information provided in this form is true, complete and accurate to the best of their knowledge. The applicant understands that this form is furnished to the insurer for the purpose of evaluating the risk and determining eligibility for coverage. Any material misrepresentation, omission or concealment of fact may be grounds for denial of coverage, rescission of the policy, or retroactive premium adjustment in accordance with the policy terms and applicable law.

The applicant authorizes the insurer or its representatives to make any investigations and inquiries necessary to evaluate this application, including obtaining loss runs and claims history from prior insurers and obtaining information from third parties regarding safety practices, financial condition, and prior loss experience. The applicant agrees to provide reasonable documentation upon request to verify statements made herein.

Signing this form does not bind coverage. Coverage is effective only upon issuance of a policy or binder by the insurer and payment of premium as required.

Additional Remarks or Material Facts

Applicant Name:

Title:

Signature:

Date:

What the Insurance Contractor Exposure Form Is

The Insurance Contractor Exposure Form documents a contractor's scope of work, site conditions, exposure to hazards, subcontractor use, and estimated contract value for underwriting and claims purposes. Insurers use the form to assess liability, general conditions, professional exposures, and endorsements needed on a policy. Contractors complete name, address, project details, limits requested, prior loss history, and safety controls. The form supports premium calculation, coverage recommendations, and risk mitigation steps tied to the specific project and contractual obligations between the contractor and policyholder.

Why this form matters for contractors and insurers

A completed Insurance Contractor Exposure Form gives underwriters accurate exposure details, reduces underwriting delays, and clarifies coverage gaps. It supports consistent risk evaluation across projects and helps document controls that may lower premiums or exclusionary endorsements.

Who completes and reviews the Insurance Contractor Exposure Form

Each party contributes different details: contractors provide operational facts, brokers coordinate submissions, and underwriters apply coverage criteria and pricing.

General contractors and subcontractors supplying project scope, payroll, and safety programs for underwriting.
Insurance brokers collecting exposures and prior-loss history to obtain competitive quotes.
Underwriters and risk managers verifying limits, endorsements, and control measures before binding coverage.

Core components to include on a professional form

A complete form has six core sections that underwriters expect. Use clear, specific entries and supporting documentation to avoid follow-up requests and to accelerate binding.

Project ID

Project name, location, and contract number. Ties the exposure to a single job and helps carriers correlate losses to policy periods.

Scope of Work

Detailed description of tasks, materials, and phases. Specify high-risk activities (hot work, demolition, excavation) so underwriters can consider endorsements or exclusions.

Contract Values

Total contract amount, annualized value if multi-year, and anticipated payroll. These figures determine exposure bases for premium and aggregate limits.

Subcontractors

List major subs, percentage of work subcontracted, and evidence of subs' insurance; helps evaluate vicarious liability and indemnity transfer.

Safety Controls

Document written safety programs, site supervision, certifications, and incident rates; effective controls can influence underwriting credits.

Loss History

Detail prior claims, reserves, and OSHA violations over the past five years; material omissions can lead to rescission or premium adjustments.

Step-by-step: completing the form from start to finish

Follow these four core steps to produce a complete submission that underwriters can review without follow-up.

01

Prepare documents: Gather contracts, sub agreements, safety plans, and loss runs before you begin.
02

Enter exposures: Populate project details, contract values, payroll, and subcontractor percentages accurately.
03

Attach support: Upload loss runs, certificates, licenses, and safety program summaries with the form.
04

Sign and submit: Have the authorized signer execute the form electronically or on paper and route to the broker or carrier.

Configure an efficient digital submission workflow

Set up fields and routing rules to automate review and reduce manual handling.

Field	Configuration
Project ID	Required, single-line text
Contract Value	Numeric field with currency format
Attach Loss Runs	File upload required, PDF preferred
Signature	Signer email + SMS authentication optional

Choosing a platform for eSubmission and eSignature

Ensure the chosen vendor supports ESIGN/UETA compliance and provides tamper-evident signed PDFs with an auditable certificate of completion.

File formats: PDF, DOCX accepted
Integrations: Supports Google Workspace, Microsoft 365, NetSuite
Authentication: Email, SMS, KBA or advanced auth

Typical eSubmission flow for the Insurance Contractor Exposure Form

A consistent signing flow reduces friction and ensures records meet legal requirements under ESIGN and UETA.

Upload document: Sender uploads the completed form and attachments to the signing platform.
Place fields: Add signature, date, and required text fields for each signer.
Send to signer: Dispatch via email link or bulk send to multiple recipients.
Receive signed copy: Signed PDF and audit trail are returned to sender and recipients.

Penalties and risks tied to incorrect or incomplete forms

Coverage rescission: Material misstatements can lead to rescission or denial of claims

Premium adjustments: Undeclared exposures may result in retroactive premium increases

Contract liability: Inaccurate subcontractor details can void intended indemnity arrangements

Regulatory fines: Failing to retain records per statute may trigger penalties

Delayed claims: Incomplete loss history slows claims handling and reserve accuracy

Audit failures: Missing signed originals or auditable e-sign trails can fail insurer audits

Common mistakes to avoid when preparing the form

Leaving contract values rounded or estimated instead of exact figures causes underwriting follow‑ups and delays.
Omitting subcontractor insurance details or certificates leads to coverage questions and possible endorsements.
Submitting unsigned or partially signed forms prevents binding and prompts re-submission requests.
Providing incomplete loss runs or aggregated claim amounts without dates undermines risk assessment accuracy.

Security and compliance checkpoints for electronic submissions

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest

Audit trail: Full timestamped signing history and IP data

Certifications: SOC 2 Type II and ISO 27001 certified

HIPAA: BAA available for protected health information

ESIGN/UETA: Compliant with federal and state e-signature laws

21 CFR Part 11: Compliance options for FDA-regulated workflows

Who is authorized to sign and certify the form

Owner / CEO

Typically the business owner or CEO signs on behalf of the contracting entity and certifies accuracy of exposures and loss history. The signer should be listed in corporate records to establish authority.

Project Manager

A designated project manager or operations officer may sign for project-specific exposure forms when authorized in writing by the contracting entity's corporate officer.

eSignature vendor comparison for signing and submitting exposure forms

Basic vendor capabilities and starting prices for common eSignature platforms. signNow is listed first in the comparison per vendor ordering rules.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Practical tips for accurate and efficient completion

Adopt consistent validation steps to reduce rework and speed underwriting.

Use templates

Standardize the exposure form with pre-filled fields for recurring clients to minimize entry errors and accelerate submissions.

Attach evidence

Include loss runs, contracts, and certs at first submission to prevent underwriting follow-up and expedite quoting.

Review signatures

Verify signer authority and date consistency before sending; mismatched dates can trigger audit questions.

Log submissions

Maintain a submission log with timestamps and policy references for audit and renewal cycles.

Timing considerations and expected processing steps

Track submission and review deadlines to avoid coverage gaps and ensure timely underwriting decisions.

Submission timing:

Provide the form before binding or renewal deadlines to allow underwriting review

Underwriter review:

Plan 3–10 business days for standard review; complex exposures may take longer

Requests for info:

Respond to follow-up questions within 48–72 hours to prevent quoting delays

Policy effective date:

Confirm that the form's effective date aligns with the requested insurance start date

Renewals:

Update the form annually or whenever material changes occur in exposure

Key milestones from submission to policy binding

A typical timeline involves submission, underwriter review, information requests, binding, and record retention.

01

Submission

Sender uploads form and supporting documents to insurer or broker.

02

Underwriter review

Underwriter assesses exposures, limits, and required endorsements.

03

Clarifications

Carrier issues questions or requests more documentation if needed.

04

Binding

Policy is issued and the completed form becomes part of the underwriting file.

Frequently asked questions about the Insurance Contractor Exposure Form

Answers to common questions about completion, legal validity, and electronic submission of the form.

Need help? Contact support

Can this form be e-signed?
Yes. Electronic signatures meeting the ESIGN Act (15 U.S.C. ch. 96) and state UETA requirements are valid if intent, consent, attribution, and record retention are documented.
Is notarization sometimes required?
Notarization is rarely required for the exposure form itself but may be needed for attached affidavits, waivers, or recorded documents depending on state law and instrument type.
What if a signer’s name differs from corporate records?
Mismatched names can delay acceptance. Provide corporate authorization or a resolution showing delegated signing authority to verify attribution.
Do I need to attach loss runs?
Yes. Underwriters commonly require loss runs for the past five years; include dates, amounts paid, and open/closed status to avoid follow-up requests.
How do remote notary sessions affect submission?
If a document requires notarization, use an approved RON provider where permitted; follow the state's identity proofing and audio-video retention rules.
What retention rules apply to signed forms?
Retain signed exposure forms per IRS and industry rules (typically at least three to seven years) and longer for HIPAA, SEC, or state-specific mandates.

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