1. Describe all professional or business services performed by applicant: 2. Number of years in business: 3. List all states in which applicant performs operations: 4. Number of employees: Total: Full Time: Part Time: 5. Total annual: Payroll: Gross Receipts: $ 6. Schedule Of Hazards: Premium Basis (s) Gross Sales Loc. Class. (p) Payroll Classification Description Exposure No. Code (a) Area (c) Total Cost (t) Other 7. List applicant’s five largest clients (projects), service provided and cost of service: Client (Project) Name: Services Provided Cost of Service 8. Provide a breakdown of the applicant’s consulting services including type of consulting activity and percent of gross receipts derived from each type of consulting activity: 9. Identify which of the following categories the applicant offers consulting services for: Animals Legal Range Management Chemicals Management/Business Real Estate Computer/Information Technology Marketing Regulatory Construction Medical Safety Engineers or Architects Nuclear Security Environmental Nutrition Social Media Financial/Investment Political Social Services Gas or Oil Public Relations Other: Irrigation 10. Does applicant provide the following services:
1. Describe all professional or business services performed by applicant: 2. Number of years in business: 3. List all states in which applicant performs operations: 4. Number of employees: Total: Full Time: Part Time: 5. Total annual: Payroll: Gross Receipts: $ 6. Schedule Of Hazards: Loc. No. Classification Description Class. Code Exposure Premium Basis (s) Gross Sales (p) Payroll (a) Area (c) Total Cost (t) Other 7. List applicant’s five largest clients (projects), service provided and cost of service: Client (Project) Name: Services Provided Cost of Service 8. Provide a breakdown of the applicant’s consulting services including type of consulting activity and percent of gross receipts derived from each type of consulting activity: 9. Identify which of the following categories the applicant offers consulting services for: Animals Chemicals Computer/Information Technology Construction Engineers or Architects Environmental Financial/Investment Gas or Oil Irrigation Legal Management/Business Marketing Medical Nuclear Nutrition Political Public Relations Range Management Real Estate Regulatory Safety Security Social Media Social Services Other: 10. Does applicant provide the following services: