Contractors New Business Application
if different from mailing
MM slash DD slash YYYY
23. Do you use subcontractors?(Required)
23 b. Do you have a standard formal written contract with Subcontractors?
23. c. Do you require all subcontractors to name you as an additional insured?
24 d. Does your contract with subcontractors include a hold harmless favoring you?
25 f. Do you require Waiver of Subrogation endorsement on CGL and W.C.?
30. Will you perform work involving or related to CONSTRUCTION, on or about the premises of Condominiums or Townhouses
31. Will you perform work involving or related to CONSTRUCTION, on or about the premises of Apartments
32. Will you perform work involving or related to CONSTRUCTION, on or about the premises of Tracts, PUD’s, or any other development, premises or project with more than 150 homes built or planned:
33. Have you ever performed work on hillsides, hilltops, slopes, cliffs, landfill or other subsidence areas, or do you plan to in the future?
34. Have or will any of your projects involve caissons, cantilevers, piers, retaining walls, shoring, underpinning, or other heavy structural engineering techniques?
35. Do you perform work above two stories in height (other than interior remodeling)?
36. Do you perform any work below ground level?
37. Have you ever or will you build, remove, repair or replace roofs?
38. Have you or will you work as a construction manager on a fee basis?
39. In the past 3 years have you been fired or replaced on a job in progress?
40. Have you or will you supervise subcontractors whose payments are run through another entity?
41. Note: the following questions apply regardless of whether the applicant was at fault for a claim or incident, and regardless of whether the claim or incident was covered by insurance. Explain any “yes” answers in the space provided below:
41a. Have there been any losses, claims or suits against you in the past 5 years?(Required)
41b. Are there any claims or legal actions pending against any of the entities named in the application?
41c. Do any of the entities named in the application have knowledge of any pre-existing act, omission, event, condition or damages to any person or property that may potentially give rise to any future claim or legal action against any such entity?
41d. Have you been accused of faulty construction in the past 5 years?
41e. Have you been accused of breaching a contract in the past 5 years?
42. For each of the following activities, check:
Yes: if the activity has or will be performed, subcontracted, or supervised by applicant. No: if the applicant has never and does not plan to perform, subcontract, or supervise the activity. Yes No Yes
a. LPG work
b. Concrete Tilt-Up Construction
c. Demolition
d. Seismic Retrofitting
e. Swimming Pool Construction
f. Boiler Installation/Repair
g. Industrial Machinery Repair or Installation
h. Use of Cranes
i. Rental of Equipment to others
j. Process Piping
k. Refineries
l. Chemical Plants
m. Hospitals
n. Road/Highway/Bridge
o. Underground Tank removal, repair or installation
p. Work on Gas Lines/Pumps
q. Asbestos or Lead Abatement
r. Environmental Cleanup
s. Dam or Levee Work
t. Traffic Signals/Control Work
u. Gas Stations
v. Airports
w. Public Utilities
x. Railroads
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