Transcription of CONCRETE CONTRACTORS Supplemental Application
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CONCRETE CONTRACTORS Supplemental Application
Page 1 of 5 03/04 Account Name !!!!! Producer Name !!!!! Account Contact Name !!!!! Producer e-mail address !!!!! Account web site address !!!!! Account e-mail address !!!!! Date Completed !!!!! Definitions of italicized terms are provided at the end of the supplement. ELIGIBILITY: 1. Please attach a list of the risk s jobs (job list) for the last two years as well as a list of the jobs committed to for the next 12 months. 2. Enter the percentage of the risk's own payroll and/or sales that emanate from the following operations: Exclude work that the risk subcontracts when determining eligibility percentages Percentages based on: (check one) Payroll or Sales Gunite work excluding EIFS !!!!!% CONCRETE maintenance and repair !!!!!% CONCRETE Paving (including ground supported CONCRETE floors, driveways, sidewalks, curbs, gutters, patios) !!!!!% CONCRETE tilt-up construction !
Page 3 of 5 03/04 10. Does the risk have any future plans related to work involving apartments, condos, townhouses, tract homes, custom homes or homes of unusual design?
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EXCESS LIABILITY SUPPLEMENTAL APPLICATION, CHILD CARE CENTER SUPPLEMENTAL APPLICATION, Contractor's Supplemental Application, Contractor’s supplemental application, MISCELLANEOUS PROFESSIONAL LIABILITY SHORT, Miscellaneous professional liability short form application, Liability, CERTIFICATE OF COVERAGE UMBRELLA AND EXCESS, CERTIFICATE OF COVERAGE UMBRELLA AND EXCESS LIABILITY INSURANCE