Exposure Questionnaire: |
|
|
|
| Act as a General Contractor? |
|
Elevators, escalators, boilers? |
|
| Alarm systems? |
|
Excavation / tunneling? |
|
| Any aircraft, railroad, watercraft or auto work? |
|
Exposure to radioactive / nuclear material? |
|
| Any bridges, dams or sewer construction work? |
|
Exterior work over 3 stories? |
|
| Any cell phone, water, gas, oil tank or tower work? |
|
Fiber optic cable work? |
|
| Any herbicides or pesticides work? |
|
Fire extinguisher systems? |
|
| Any out-of-state operations? |
|
Have you ever been named in a construction defect suit? |
|
| Any prior losses in the last 5 years? |
|
Mobile home or related work? |
|
| Any roofing or roof related work? |
|
Mold / fungus remediation work? |
|
| Any work with cranes of any height, owned or leased? |
|
Operated as an inspection or appraisal company? |
|
| Any work with LPG? |
|
Ops involving discharge of fumes, acids or waste? |
|
| Asbestos abatement? |
|
Prefab steel construction? |
|
| Blasting, demolition or any explosive materials used? |
|
Rent, lease or repair equipment? |
|
| Chemical spraying / fumigating? |
|
Tree or limb removal? |
|
| Coal, wood, waste or oil burning stoves? |
|
Underpinning / foundation repair? |
|
| Digging more than 3 feel underground? |
|
Waste removal? |
|
| Does applicant draw plans, designs or specifications? |
|
Waxing floors in commercial buildings or stores? |
|
| Explain any Yes answers |
|
Work involving medical and / or industrial equipment? |
|
|
|
|
|
| |
|
|
|
