Insured/Applicant Policy/Quote Number Insured’s Website Address Describe Applicant’s operation in detail Types of Jobs: Residential Work % Commercial Work % Industrial Work % Municipal Work % New Construction % Remodeling % Service or Repair % Other* % *Describe “Other” Licenses and Jurisdictions: License Jurisdiction Description of three largest jobs: Description of Job Location Date Cost $ $ $ Operations: Plumbing % Electrical % Heating % Refrigeration % Metal % Air Conditioning % Other % Describe “Other” Heating Work: Hot Water % Oil % Electric % Hot Air % Natural Gas % *Coal % Heat Pump % *LP Gas % *Wood % Steam Vessel % *Solar % *Please Describe LP Gas/Coal/Wood/Solar: GENERAL INFORMATION SECTION: Number of Employees: Full time Part Time Annual Payroll $ Annual Receipts: $ Does the applicant sign a written contract with its customers? (If yes, attach a sample copy) Yes No Are subcontractors used? Yes No Cost $
Insured/Applicant Policy/Quote Number Insured’s Website Address Describe Applicant’s operation in detail Types of Jobs: Residential Work % Commercial Work % Industrial Work % Municipal Work % New Construction % Remodeling % Service or Repair % Other* % *Describe “Other” Licenses and Jurisdictions: License Jurisdiction Description of three largest jobs: Description of Job Location Date Cost $ $ $ Operations: Plumbing % Electrical % Heating % Refrigeration % Metal % Air Conditioning % Other % Describe “Other” Heating Work: Hot Water % Oil % Electric % Hot Air % Natural Gas % *Coal % Heat Pump % *LP Gas % *Wood % Steam Vessel % *Solar % *Please Describe LP Gas/Coal/Wood/Solar: GENERAL INFORMATION SECTION: Number of Employees: Full time Part Time Annual Payroll $ Annual Receipts: $ Does the applicant sign a written contract with its customers? (If yes, attach a sample copy) Yes No Are subcontractors used? Yes No Cost $