Applicant Information
What is the name of the applicant? *
What is the applicant’s address? *
What is the applicant’s website address? (Enter http:// or https:// first)
What is the applicant’s email address? *
What is the first name of the contact person for the applicant? *
What is the last name of the contact person for the applicant? *
What is their phone number?
What year was the applicant’s business established?
What type of entity is the applicant?
What date would you like this insurance to commence?
What type of contracting operation does the Applicant have?
How many years experience does the Applicant have in this type of operation?
How many years has the Applicant been in business?
How many years has the Applicant been in business under this business name and the same management?
Has the Applicant changed names in the last 5 years?
Please provide an explanation for the name changes.
Has the Applicant operated other business entities in the last 5 years?
Please provide details of the other business entities the Applicant has operated in the last 5 years.
Has the Applicant discontinued operations in the last 10 years?
Please provide an explanation for discontinuing operations.
Please provide the payroll information requested below.
Please provide the receipts information requested below.
Work Profile
Please select the type(s) of work the Applicant performs. *
What percent of the work the Applicant performs is new construction?
What percent of the work the Applicant performs is structural renovation?
What percent of the work the Applicant performs is other renovation?
What percent of the work the Applicant performs is condo conversion work?
What percent of the work the Applicant performs is maintenance work?
What percent of the work the Applicant performs is demolition work?
What percent of the work the Applicant performs is interior?
What percent of the work the Applicant performs is exterior?
What percent of the work the Applicant performs is wrap-up projects?
What percent of the work the Applicant performs is Non-Wrap projects?
Please select the type(s) of construction contracts the Applicant takes on.
What percent of the Applicant’s work is as the GC?
What percent of the Applicant’s work is as the Prime Contractor?
What percent of the Applicant’s work is as the Subcontractor?
What percent of the Applicant’s work is as the CM?
What percent of the Applicant’s work is as a Building Supply Co.?
What percent of the Applicant’s work is as the Owner?
What percent of the Applicant’s work is as the Property Manager?
Please select the sub-industries the Applicant is involved with, if any.
Construction Projects
Please select the type(s) of building projects the Applicant is involved with.
What percent of the Applicant’s construction projects are for Commercial Building projects?
What percent of the Applicant’s construction projects are for Industrial Building projects?
What percent of the Applicant’s construction projects are for Institutional Building projects?
What percent of the Applicant’s construction projects are for Residential Building projects?
Please select the type(s) of non-building projects the Applicant is involved with.
What percent of the Applicant’s non-building projects are for Surface Transportation projects?
What percent of the Applicant’s non-building projects are for Energy Related projects?
What percent of the Applicant’s non-building projects are for Utility-under or above ground projects?
What percent of the Applicant’s non-building projects are for Other projects?
Residential Building Projects Breakout
What percentage of the Applicant’s residential building projects are for tract housing (housing developments, single family, townhouse)?
What percentage of the Applicant’s residential building projects are for spec homes?
What percentage of the Applicant’s residential building projects are for apartments?
What percentage of the Applicant’s residential building projects are for condominiums?
What percentage of the Applicant’s residential building projects are for dormitories?
What percentage of the Applicant’s residential building projects are for military barracks?
What percentage of the Applicant’s residential building projects are for retirement communities (Assisted/Independent/Nursing Homes)?
Employee Information
How many full-time employees does the Applicant employ?
How many part-time employees does the Applicant employ?
How many job specific hires does the Applicant make annually?
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The Applicant’s total number of employees is below.
What is the average size of the Applicant’s core workforce?
Select the turnover rate that is most applicable to the Applicant’s core labor force.
What is the average size of the Applicant’s field supervision workforce?
Select the turnover rate that is most applicable to the Applicant’s field supervision employees.
Does the Applicant perform Pre hire/Post hire physical examinations?
Does the Applicant perform Pre hire/Post hire drug & alcohol screenings?
Does the Applicant use an Employee Leasing Company?
Does the Applicant require background checks for all new hires?
Is training provided to all new employees?
Is training provided to all employees annually?
Is training specific to a project provided to employees?
Do the Applicant’s employees have continuing education requirements?
Applicant Operations
What percent of the Applicant's work is two stories and below?
What percent of the Applicant's work is above two stories?
What percent of the Applicant's work is above ten stories?
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Total Percentage Check
Does the Applicant rent construction equipment to others with or without operators?
Please upload a copy of the rental agreement.
Does the Applicant use scaffolding?
What height does the Applicant use scaffolding to? (In feet)
Does the Applicant allow other contractors at the job site to use their scaffolding?
Please explain what risk transfer is used for the other contractors using the Applicant’s scaffolding?
Does the Applicant contact utilities prior to digging?
Does the Applicant record the locate ticket, wait for the “required wait period” and renew the locate ticket before it expires?
Does the Applicant rent cranes to others or from others? (Select all that apply)
Does the Applicant rent cranes with or without operators? (Select all that apply)
Project Site Security
Is the job site secured?
Is the job site locked?
Is the job site fenced?
Is job site security provided at night?
Are security services subcontracted?
Are security services armed?
Are pre-construction job site hazard analyses performed?
Are pre-construction job site hazard analyses performed for all jobs?
Are pre-construction job site hazard analyses performed based on size and complexity?
Does the Applicant have a written Safety Program?
Does the Applicant hold regular safety meetings?
Does the Applicant have a new employee orientation policy and training?
Does the Applicant have supervisor training (Competent Person)?
Does the Applicant have vehicle safety policies, including a distracted driving policy?
Does the Applicant have guidelines for personal autos used in the business of the Insured?
Does the Applicant have guidelines for personal use of insured vehicles?
Does the Applicant have written job safety procedures?
Does the Applicant have a fall protection policy and training?
Does the Applicant have mobile equipment procedures and training?
Does the Applicant have material handling/lifting training?
Does the Applicant provide required PPE (personal protective equipment) with training on proper use?
Quality Control Program
Are certificates of insurance (COI) obtained from all suppliers?
Are foreign made materials to be installed imported directly by the contractor?
Do ‘Completed Projects’ records included photographs, documentation, and sign off by the customer(s)?
Unmanned Aircraft Use (AKA Drones)
Does the Applicant use or operate drones in the course of their business operations?
Does the Applicant carry Aircraft Liability coverage for all drones used in the Insured’s business?
Are all drone operators/pilots formally trained and approved operators?
Please enter the dimensions and weight of each drone used. (Use the + button to add additional drones.)
Please enter the make and model numbers of all drone used. (Use the + button to add additional drones)
What is the business purpose of the drone(s) used?
Contracting Information (If applicable please reply to the following questions)
Contracting Information (If applicable please reply to the following questions)
Does the Applicant hire subcontracts?
What is the annual cost of subcontractors (cost includes labor and materials)?
Does the Applicant use a written contract all the time?
Please attach a copy of the contract the Applicant uses when hiring subcontractors.
Does the Applicant’s contract require the subcontractor to provide DEFENSE, INDEMNIFICATION & HOLD HARMLESS protection to the fullest extent permitted by law?
Does the Applicant’s contract require the subcontractors to add the Applicant as an Additional Insured (AI) for Premises/Operations AND Completed Operations?
Does the Applicant's contract require the subcontractor to provide the Applicant with PRIMARY & NONCONTRIBUTORY status on Additional Insured (AI) position?
Does the Applicant's contract require the subcontractor have insurance with a carrier that has a minimum AM Best rating of A- or better?
Does the Applicant's contract specify the minimum limits the subcontractor must carry?
Does the Applicant's contract require the contract has been reviewed within the past 3 years by an attorney with contract law experience in all states where work is performed?
Does the Applicant's contract require the Additional Insured (AI) endorsement for a specific period after the job is completed?
Does the Applicant's contract require the subcontractor to have a designated person with responsibility for maintaining oversight of all contracts, including management of the evidence of continuing insurance throughout the duration of the projects(s)?
Does the Applicant’s contract require the subcontractor to deliver copies of the Additional Insured endorsements (annually)?
What percentage of the Applicant's work is subbed out?
Please list the trade types contracted with and the corresponding cost or % of the total cost for each trade.
Contracts the Account Enters When Acting as a Sub-Contractor
Does the owner or assigned individual review all contracts for acceptability of indemnity and insurance requirement provisions?
If the Applicant is acting as a sub-contractor, will the Applicant decline to bid/accept a project if unacceptable indemnity or insurance requirements are not altered to be favorable to them?
Construction Defects
Within the past 10 years, does the Applicant have knowledge of any pre-existing act, omission, event, condition or damage to any person or property that may potentially give rise to any future claim or legal action?
Please explain
Within the past 10 years, has the applicant been named in any claims and/or litigation regarding faulty or defective construction or workmanship?
Please explain.
Does the Applicant retain all job files for a least the statute of repose time period for each state where they do work?
Does the Applicant have a formal and documented quality control program?
Pollution
Has the Applicant had any pollution-related losses or events in the last 5 years?
Please explain.
Is the Applicant aware of any circumstance they have been involved in that could result in a pollution-related claim?
Please explain.
In the past 5 years, has the Applicant been cited or fined for any contracting activities?
Please explain.
Does the Applicant handle, transport, store on site, or deliver fuel or other pollutants?
Does the Applicant want a SPEC (Stand Alone Pollution Policy) policy?
What is the current pollution policy carrier’s name?
What are the current pollution policy coverage limits?
What is the expiring premium?
What is the retention?
What is the effective date?
What is the retroactive date?
Job Listing
Please list the last 5 jobs the Applicant has worked on during the last year, or attach a copy of jobs completed in the last 12 months. (Use the + button to add additional jobs.)
If you are attaching a copy of the jobs completed in the last 12 months, use the button below to do so.
Please provide details of the 5 largest jobs the applicant has worked on:
Please list all states the Applicant has performed work in the last 10 years. (Use the + button to add additional jobs.)
Please list all states the Applicant expects to perform work in this year. (Use the + button to add additional jobs.)
What is the average size of jobs (cost) the Applicant will take on?
On average, how many jobs are ongoing at the same time?
How many jobs were completed during the last 12 months?
Does the Applicant use a written contract with all customers?
How long does the Applicant maintain records of contracts and job records?
What percentage of the Applicant's work is performed within a radius of 50 to 200 miles from base locations?
What percentage of the Applicant's work is performed within a radius of less than 50 miles from base locations?
What percentage of the Applicant's work is performed within a radius of greater than 200 miles from base locations?
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Total Percentage Check (100%)
On average, what is the number of job sites attended by a core worker?
Do job sites involve work near or on roadways or walkways?
What percent of the Applicant's work is performed during the day?
What percent of the Applicant's work is performed at night?
What percent of the Applicant's work is performed 7 days per week?
What percent of the Applicant's work is performed for 24 hours?
Work Performed
Does the Applicant perform or has the Applicant ever performed, directly or though a subcontractor, any of the following work? (If Yes or Subbed, please describe in the applicable field.)
Please provide an explanation of the Airport Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Alternative Energy - Wind/Solar/Other Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Amusement Park Construction performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Architectural or Engineering Design Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Asbestos Removal or Remediation Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Automatic Sprinkler/Fire Suppression Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Blasting/Work with Flammables or Explosives performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Boiler/High Pressure Systems Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Bridge Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Chemical or Petrochemical Sites Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Construction or Project Manager Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Dam/Cofferdam/Levee Construction Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Design - Build Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the EIFS/Stucco Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Environmental/Pollution/Mold Remediation Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Escalator or Elevator Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Fire/Burglar Alarms (installation or monitoring) Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Fire/Water Damage Restoration Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Fireproofing Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Gas Mains/Piping/LPG Work/Flammables Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Gas/Oil (O&G) Field Related Work (incl. routine tasks done for O&G sites) performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Hazardous Waste Removal Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the High Voltage/Power Lines/Transformers Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Hospitals Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Landfill/Water Disposal Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Lead Abatement Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Millwright, Equipment moving or Rigging Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Pesticide/Herbicide Application Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Pile Driving Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Power Generator Sites Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Railroad Construction Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Roofing Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Snowplowing/Sanding Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Solar Panel Installation Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Subway or Tunnel Construction Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Traffic Signal Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Transporting or Disposing or Hazardous Waste Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Above/Underground Storage Tank (painting, removal or installation) Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Please provide an explanation of the Waterproofing Work performed by the Applicant or Sub-Contractor. (Specify who performed the work, the Applicant or the Sub-Contractor)
Documents and Comments
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Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.
Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes. *
