CONTRACTORS QUESTIONNAIRE – VELA …

1 January 2002 (rev. 05/01/05)1 CONTRACTORS QUESTIONNAIRE VELA insurance SERVICESALL QUESTIONS MUST BE ANSWERED (Attach additional paper if necessary)1. Applicant: _____A. Years in business under current name: _____B. Describe your Operations: _____C. Do you have any other operations active or inactive?YesNo If yes, please explain: _____2. contractor s license number: _____ States in which you do business: _____A. New York State Applicants: Any work in the five boroughs of New York?YesNo3. List all other business names & licenses active or inactive applicant has used in the past 10 years:_____A.

2 What were the operations? _____4. Does applicant currently own/operate any other business?YesNoIf yes, need name and percentage of ownership: _____What are the operations? _____5. Percentage of current operations: General contractor ____% Subcontractor ____% Constr. Mgr: ____%6. Do you use Subcontractors?YesNo If yes, please complete the following:A. Percentage of subcontracted work: _____%B. Annual subcontracting cost (including all of subs labor and materials: $_____7. Do you collect certificates from all subcontractors?)

3 Yes NoA. What limit is required from these subcontractors?$_____8. Estimates for next 12 months:Payroll $_____ Sub-Contract Cost $_____ Gross Receipts: $_____4 Years Prior History if Applicable:1st YearGross Receipts: $_____2nd YearGross Receipts: $_____3rd YearGross Receipts: $_____4th YearGross Receipts: $_____9. Indicate the percentage of construction work preformed by you: (MUST TOTAL 100%) RESIDENTIAL _____% COMMERCIAL _____%New Construction_____%New Construction_____%Remodeling/Repair _____%Remodeling/Repair_____%Other _____ _____%January 2002 (rev.)

4 05/01/05)210. Using percentage of payroll (under Direct) and percentage of contract costs (under Subbed), indicate theanticipated percentage of construction work you will perform over the next 12 months:Type of Work%Direct%SubbedType of Work %Direct%SubbedType of Work%Direct%SubbedAirport RunwaysExcavationRoofingBlastingHVACS eismic/RetrofittingBridge BuildingGradingSewerCarpentryInsulationS teel/StructuralConcreteMaintenanceSteel/ OrnamentalDemolitionMasonryStreet/RoadDr illingMechanicalSupervisory OnlyDrywallPaintingTraffic SignalsEarthquakePlasteringWater/Gas MainsElectricalPlumbingOther:11.

5 Describe your four largest projects over the past five years, including values:_____12. List current projects currently underway or planned for the next year, including values:_____13. How many new homes will you build from the ground up in the next year?_____14. Have you ever built a home from the ground up? YesNoA. How long ago? _____B. How many? _____15. How many additional insured endorsements do you anticipate needing in the next year? _____16. How many Waivers of Subrogation do you anticipate needing in the next year?

6 _____17. Have you allowed or will you allow your license to be usedby any other contractor for a project on which you have worked?YesNoA. Has any other licensing authority taken any action against you?YesNo18. Have you built or will you build on hillsides, terraces, landfills orSubsidence areas? YesNoIf yes, please explain: _____19. Do you use scaffolding?YesNoIf yes, please explain: _____20. Have you been involved or will you be involved with blastingoperations or any other hazardous work activity?YesNoIf yes, please explain: _____January 2002 (rev.)

7 05/01/05)321. Do you perform synthetic stucco work (EIFS)? YesNo22. Do any of your subcontractors perform EIFS work?YesNo23. Have you built/demolished or will you build/demolishbuildings or other structures in excess of four (4) stories?YesNoIf yes, please explain: _____24. Do you perform work above two stories in height? (other than interior remodel) YesNoIf yes, what percentage? _____%Maximum Height? _____Please describe: _____25. Do you perform any work at Airports? YesNoIf yes, please explain: _____26. Do you own, rent or subcontract any cranes?

8 YesNoIf yes, please explain: _____27. Have you been involved or will you or your subcontractors beinvolved in any removal of asbestos, PCB s or other hazardous materials?YesNo28. Removal or work on fuel tanks or pipelines?YesNo29. If you are a roofing contractor , subcontractor or performing roofing work, do you use:Hot Tar_____%YesNoTorch DownYesNoModified Bitumen (HOT)YesNoModified Bitumen (COLD)YesNoHot Air Welding_____%YesNoOther: _____30. Do you perform any Mold Remediation Work?YesNo31. Do any of your subcontractors perform Mold Remediation Work?

9 YesNoA. If yes, is coverage in place?YesNoB. Name of Carrier?_____32. Have you performed or will you or your subcontractors performany work below grade:YesNoMaximum Depth: _____Feet% of operations: _____33. Any shoring, underpinning, cofferdam or caisson work?YesNoIf yes, please explain: _____34. Have you worked or will you or your employees work Longshoremen s and Harbor Workers Act or Jones Maritime Act?YesNo35. Do you have a formal safety program in place?YesNoJanuary 2002 (rev. 05/01/05)436. Will any work involve the construction of or involvement withCondominiums or Townhouses?

10 YesNoA. If yes, is the work new construction?YesNoB. Repair or Remodel only?YesNo37. Will any work involve the construction of or involvement with Apartments?YesNoA. If yes, is the work new construction?YesNoHow many units in the ENTIRE Project? _____B. Repair or Remodel only?YesNo38. Will any work involve the construction of or involvement with new Duplexes,Triplexes, Fourplexes or Patio Homes? YesNo39. Have you ever worked in new Duplexes, Triplexes, Fourplexes or Patio Homes? YesNoIf yes, how long ago?