ROOFING CONTRACTORS SUPPLEMENTAL …

Please send submissions to: ROOFING CONTRACTORS SUPPLEMENTAL APPLICATION SUBMISSION REQUIREMENTS Complete signed / dated SUPPLEMENTAL Application(s) Completed ACORD applications Currently valued insurance company loss runs for the current policy period plus four (4) prior years Description of all claims Sample contracts entered into with sub-contractorsACCOUNT INFORMATION Applicant Name: contractor s License(s) #: Mailing address: City: State: Zip: Website: www. Risk Management Contact: Risk Management s Phone: Risk Management Email: SECTION I GENERAL INFORMATION in business under current name:Years other names which the Applicant has conducted (s) in which the Applicant will do or has done operations in New York?Yes No If yes,% in New York City, Long Island and Westchester County % in remainder of state Any operations in Colorado?Yes No If yes, % of residential work of operations:General contractor : % Sub- contractor : % Prime contractor : % of work to be performed by the Applicant or on their behalf:Construction types: Residential: % + Commercial/ Industrial: % =100% Indicate Split of RESIDENTIAL work ConstructionSingle Family Tract % (Check here if none ) Single Family Custom % Condo/Townhome/Townhouse % Commercial Including Apartments % Solar panel Installation % Other: % , Repair & Replacement Single Famil

Please send submissions to: submissions@tmsic.com. ROOFING CONTRACTORS SUPPLEMENTAL APPLICATION . SUBMISSION REQUIREMENTS • Complete signed / dated Supplemental Application(s)

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