If yes, describe: 9. Off-Site/Mobile Operations: a. Are fire extinguishers and first aid kit taken to each job site? Yes No Describe site preparation procedures taken to prevent fire losses or injury to others: b. 10. Does the applicant subcontract work to others? Yes No If yes, describe type of work subcontracted: 11. Any work done on existing Oil or Gas Lines? Yes No If yes, are all lines purged and flushed prior to welding? Yes No Are the lines ever pressurized during the work Yes No 12. Does the applicant rent welding equipment or supplies to others? Yes No If yes, annual receipts: $ 13. Does the applicant repair welding equipment for others? Yes No If yes, are you factory authorized for such repairs? Yes No 14. Does applicant operate a machine shop? Yes No 15. Does applicant sell welding rods (wholesale or retail)? Yes No 16. Does the applicant offer rental, sales, service, filling or refilling of gas cylinders? Yes No If yes, annual receipts: $ 17. Does the applicant build or manufacture a finished product? Yes No If yes, describe type of products manufactured: 18. Does applicant or subcontractor use explosives? Yes No If yes, describe: 19. Does applicant perform any welding operations over three stories? Yes No 20. Hold-Harmless Agreements: Does the applicant use a standard client contract, which outlines the specific responsibilities of the a. applicant? Yes No b. Do others hold applicant harmless? Yes No c. Does applicant agree to hold any third party harmless? Yes No d. Does applicant assume, by contract or verbally, responsibility for any injury or damage that may occur? Yes No 21. Does applicant in force? Yes No have Workers’ Compensation coverage 22. Does applicant lease employees? Yes No 23. Does applicant have Professional Liability coverage in force? Yes No 24. Attach (a) Any descriptive advertising literature; (b) Copy of standard contract with clients; applicants’ (c) Copies of all agreements in which the applicant has assumed liability; and (d) Separate detailed narrative descriptions as required.
If yes, describe: 9. Off-Site/Mobile Operations: a. Are fire extinguishers and first aid kit taken to each job site? Yes No b. Describe site preparation procedures taken to prevent fire losses or injury to others: 10. Does the applicant subcontract work to others? Yes No If yes, describe type of work subcontracted: 11. Any work done on existing Oil or Gas Lines? Yes No If yes, are all lines purged and flushed prior to welding? Yes No Are the lines ever pressurized during the work Yes No 12. Does the applicant rent welding equipment or supplies to others? Yes No If yes, annual receipts: $ 13. Does the applicant repair welding equipment for others? Yes No If yes, are you factory authorized for such repairs? Yes No 14. Does applicant operate a machine shop? Yes No 15. Does applicant sell welding rods (wholesale or retail)? Yes No 16. Does the applicant offer rental, sales, service, filling or refilling of gas cylinders? Yes No If yes, annual receipts: $ 17. Does the applicant build or manufacture a finished product? Yes No If yes, describe type of products manufactured: 18. Does applicant or subcontractor use explosives? Yes No If yes, describe: 19. Does applicant perform any welding operations over three stories? Yes No 20. Hold-Harmless Agreements: a. Does the applicant use a standard client contract, which outlines the specific responsibilities of the applicant? Yes No b. Do others hold applicant harmless? Yes No c. Does applicant agree to hold any third party harmless? Yes No d. Does applicant assume, by contract or verbally, responsibility for any injury or damage that may occur? Yes No 21. Does applicant have Workers’ Compensation coverage in force? Yes No 22. Does applicant lease employees? Yes No 23. Does applicant have Professional Liability coverage in force? Yes No 24. Attach (a) Any descriptive advertising literature; (b) Copy of applicants’ standard contract with clients; (c) Copies of all agreements in which the applicant has assumed liability; and (d) Separate detailed narrative descriptions as required.
Welding%20Brazing%20Cutting%20Supplemental%20Application.docx