3. Plans For The Building(s): Loc. No. 1 Loc. No. 2 Loc. No. 3 If sprinklered, is sprinkler system turned off? Yes No Yes No Yes No If yes, explain: Has building been condemned? Yes No Yes No Yes No Is building to be demolished or remodeled? Yes No Yes No Yes No If yes: Describe the work to be done: Expected start date: Expected completion date: Who is performing the work? a. Licensed contractor: b. Applicant acting as general contractor: c. Other (describe): Are all subcontractors required to General Liability Yes No Yes No Yes No insurance? Are certificates of insurance obtained from contractors Yes No Yes No Yes No or subcontractors? Are all subcontractors required to carry Workers Yes No Yes No Yes No Compensation insurance? Does applicant obtain a written contract from contrac- tor containing hold-harmless clause in favor of the Yes No Yes No Yes No applicant? Estimated cost for renovation/remodel operations: During next twelve (12) months: $ $ $ For entire project: $ $ $ If applicant is acting as the general contractor: Is scaffolding owned, rented or erected by the applicant? Yes No Yes No Yes No Will applicant occupy the building upon completion? Yes No Yes No Yes No Is vacant building a condominium or townhouse? Yes No Yes No Yes No If yes: Is it by or in the name of the developer or builder? Yes No Yes No Yes No Is this a condominium or townhouse a conversion? Yes No Yes No Yes No 4. Does risk engage in the generation of power, other than emergency back-up power, for their own use or sale to power companies? Yes No If yes, describe: 5. Does applicant have business ventures for which coverage is not requested? Yes No If yes, explain and advise where insured: 6 How long has the applicant owned property at this location? 7. Is the property in receivership, foreclosure, repossession or bankruptcy (current or previous)?
3. Plans For The Building(s): Loc. No. 1 Loc. No. 2 Loc. No. 3 If sprinklered, is sprinkler system turned off? Yes No Yes No Yes No If yes, explain: Has building been condemned? Yes No Yes No Yes No Is building to be demolished or remodeled? Yes No Yes No Yes No If yes: Describe the work to be done: Expected start date: Expected completion date: Who is performing the work? a. Licensed contractor: b. Applicant acting as general contractor: c. Other (describe): Are all subcontractors required to General Liability insurance? Yes No Yes No Yes No Are certificates of insurance obtained from contractors or subcontractors? Yes No Yes No Yes No Are all subcontractors required to carry Workers Compensation insurance? Yes No Yes No Yes No Does applicant obtain a written contract from contrac- tor containing hold-harmless clause in favor of the applicant? Yes No Yes No Yes No Estimated cost for renovation/remodel operations: During next twelve (12) months: $ $ $ For entire project: $ $ $ If applicant is acting as the general contractor: Is scaffolding owned, rented or erected by the applicant? Yes No Yes No Yes No Will applicant occupy the building upon completion? Yes No Yes No Yes No Is vacant building a condominium or townhouse? Yes No Yes No Yes No If yes: Is it by or in the name of the developer or builder? Yes No Yes No Yes No Is this a condominium or townhouse a conversion? Yes No Yes No Yes No 4. Does risk engage in the generation of power, other than emergency back-up power, for their own use or sale to power companies? Yes No If yes, describe: 5. Does applicant have business ventures for which coverage is not requested? Yes No If yes, explain and advise where insured: 6 How long has the applicant owned property at this location? 7. Is the property in receivership, foreclosure, repossession or bankruptcy (current or previous)?
Vacant%20App.docx