Personal Information
Is this company a subsidiary of another company? *
Business Type *
State *
Have there been any mergers, acquisitions, consolidations or dissolution? *
Please select the type(s) of client you have: *
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Do you perform services in the State of New York? *
Does the firm use written contracts on every project? *
Does your company use a standard written contract with clients? *
If you do not use a standard contract, how are non-standard client agreements reviewed? *
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Does your contract contain a limitation of liability and an aribtration clause? *
Which of the following does your contract contain? *
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Do you use subcontractors? *
When hiring subcontractors, check off all that apply: *
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Are subconsultants and subcontractors hired under a written, standard subcontract? *
Does the firm obtain continuing education for professional employees? *
Does the firm have in-house quality control procedures? *
Does your firm have a written health and safety procedures? *
Does your firm have a formal procedures manual? *
Do you ever perform operations or services within 50 feet of a railroad? *
Does your firm have any aircraft of watercraft exposures? *
Does your firm engage in operations involving Exterior Insulation and Finishing Systems? (EIFS) *
Do you provide written warranties for your work? *
Select all coverages desired: *
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Do you currently have insurance? *
Effective Date *
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Current Policy End Date *
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In the past 5 years, has any claim, suit, or notice of incident been made against your firm, a predecessor firm or an organization for which your firm has assumed liabilities? *
In the past 5 years, has any member of your firm or a related entity aware of any circumstances that could result in a claim, suit or notice of incident being brought against them? *
Has any entity proposed for insurance closed, sold, merged with or acquired any company in the past 12 months or anticipates doing so in the next 12 months? *
Has any Insurer cancelled, restricted or refused to renew your Liability insurance policy in the past 5 years? *
Has applicant, or any affiliated, related or predessor entity ever been (or is currently) the subject of bankruptcy, reorganization, solvency, dissolution, or other debtor proceeding, or has it made an assignment for the benefit of creditors? *
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