SECTION E: CLAIMS Has any suit or notice of incident been made against the applicant reported under any Commercial General Liability, Contractors Pollution Liability, or Professional Liability policies within the past 3 years? Yes No If yes, please attach full details on each incident. Are you aware of any facts, circumstances, or situation which could result in any claim, suit or notice of incident against you or any other entity for which coverage is being requested? Yes No If yes, please attach full details on each incident. SECTION F: ENVIRONMENTAL CONTRACTING OPERATIONS Check here if this section does not apply PROJECTED GROSS % SUBBED PROJECTED GROSS % SUBBED OPERATIONS OPERATIONS REVENUE TO OTHERS REVENUE TO OTHERS Abatement Contracting - Back/Restoration Asbestos Abatement Contracting - Debris Removal (Hazardous Lead Materials) Abatement Contracting Debris Removal (Non - Mold Hazardous/Waste) Air Duct Cleaning Drilling Alternative Energy Contracting Emergency/Spill Response – Solar Fire (No Build Back) Alternative Energy Contracting Emergency/Spill Response Wind (Rolling Stock/Vessel Spill) Alternative Energy Contracting Fire & Water Damage Other Restoration Work Bio Remediation (Soil, Water) Mobile Incinerator Mold Prevention Soil Remediation (Petroleum) Fuel System Installation Soil Remediation (Other) Groundwater Remediation Soil Removal Illegal Drug Lab Cleanup Tank and Pipe Cleaning Indoor Air Quality Tank - AST Contracting Tank - UST Installation Industrial Cleaning Contracting Lab Packing and Tank - UST Removal Sampling Contracting Trucking Hazardous – Landfill Construction Materials Contracting – Liner Installation Hazardous Materials Liquid Waste Contracting – Management and Materials Treatment Waste Water Facility Medical/Infectious Waste/Crime Scene Cleanup Operators
SECTION E: CLAIMS Has any suit or notice of incident been made against the applicant reported under any Commercial General Liability, Contractors Pollution Liability, or Professional Liability policies within the past 3 years? Yes No If yes, please attach full details on each incident. Are you aware of any facts, circumstances, or situation which could result in any claim, suit or notice of incident against you or any other entity for which coverage is being requested? Yes No If yes, please attach full details on each incident. SECTION F: ENVIRONMENTAL CONTRACTING OPERATIONS Check here if this section does not apply OPERATIONS PROJECTED GROSS REVENUE % SUBBED TO OTHERS OPERATIONS PROJECTED GROSS REVENUE % SUBBED TO OTHERS Abatement Contracting - Asbestos Back/Restoration Abatement Contracting - Lead Debris Removal (Hazardous Materials) Abatement Contracting - Mold Debris Removal (Non Hazardous/Waste) Air Duct Cleaning Drilling Alternative Energy Contracting Solar Emergency/Spill Response – Fire (No Build Back) Alternative Energy Contracting Wind Emergency/Spill Response (Rolling Stock/Vessel Spill) Alternative Energy Contracting Other Fire & Water Damage Restoration Work Bio Remediation (Soil, Water) Mobile Incinerator Mold Prevention Soil Remediation (Petroleum) Fuel System Installation Soil Remediation (Other) Groundwater Remediation Soil Removal Illegal Drug Lab Cleanup Tank and Pipe Cleaning Indoor Air Quality Tank - AST Contracting Industrial Cleaning Tank - UST Installation Contracting Lab Packing and Sampling Tank - UST Removal Contracting Landfill Construction Trucking – Hazardous Materials Liner Installation Contracting – Hazardous Materials Liquid Waste Management and Treatment Contracting – Materials Medical/Infectious Waste/Crime Scene Cleanup Waste Water Facility Operators