Personal Information
Business Type *
State *
CONTRACTING OPERATIONS (select all that apply) *
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Do you currently have insurance? *
Effective Date *
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Current Policy End Date *
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Please select the type(s) of client you have: *
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Do you perform services in the State of New York? *
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? *
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? *
Any past, present or future work on hillsides, hilltops or terraces?
Any past, present or future work on landfill areas or in subsidence areas? *
Any past, present or future construction operations conducted in excess of 2 stories? *
Any past, present or future exterior work performed above 2 stories in height from grade? *
Any past, present or future work performed below grade? *
Any past, present or future involvement in the construction of condos, townhouses or apartments? *
Any past, present or future involvement in the building of Tract Housing Developments? (Tract defined as 6 or more homes in the same subdivision) *
Do you draw any plans or blueprints used in your construction work? *
Have you ever been named in a construction defect suit? *
Do you have a formal safety program in operation? *
Do you own lease any heavy equipment? *
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 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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