Contractor Questionnaire

Complete all questions below. The information collected assists in the insurance underwriting process and is used to determine insurability. All questions must be answered.

Section 1 of 8

1 Business Information

1. Applicant (Business Name) *

A. Years in business under current name

2. Contractor's License Number

B. Describe your Operations

States in which you do business

C. Do you have any other operations active or inactive?

Yes No

A. New York State Applicants: Any work in the five boroughs of New York?

Yes No

3. List all other business names & licenses (active or inactive) used in the past 10 years

A. What were the operations?

4. Does applicant currently own/operate any other business?

Yes No

2 Operations & Financial Estimates

5. Percentage of current operations (must total 100%)

General Contractor %

Subcontractor %

Construction Manager %

6. Do you use Subcontractors?

Yes No

7. Do you collect certificates from all subcontractors?

Yes No

8. Estimates for next 12 months

Payroll

Sub-Contract Cost

Gross Receipts

# Full-time employees

# Part-time employees

# Owners

4 Years Prior Gross Receipts (if applicable)

1st Year

2nd Year

3rd Year

4th Year

3 Construction Type Percentages

Questions 9 & 10 — All percentages in each category must total 100%.

Residential

Total Residential %

New Construction %

Remodeling/Repair %

Commercial

Total Commercial %

New Construction %

Remodeling/Repair %

Other type (describe)

Other %

10. Percentage of work by type (% Direct payroll / % Subbed contract cost)

Type of Work	% Direct	% Subbed	Type of Work	% Direct	% Subbed
Airport Runways			Excavation
Blasting			HVAC
Bridge Building			Grading
Carpentry			Insulation
Concrete			Maintenance
Demolition			Masonry
Drilling			Mechanical
Drywall			Painting
Earthquake			Plastering
Electrical			Plumbing
Roofing			Seismic/Retrofitting
Sewer			Steel/Structural
Steel/Ornamental			Street/Road
Supervisory Only			Traffic Signals
Water/Gas Mains			Other

4 Project History

11. Describe your four largest projects over the past five years (include values)

12. List current projects underway or planned for the next year (include 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?

Yes No

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?

Contractor Questionnaire

Residential

Commercial

WARRANTY

Thank you for your submission