PROPERTY AND LIABILITY INSURANCE APPLICATION

SECTION ONE - GENERAL INFORMATION Your Name: (i.e. Bob Smith) Your Email: Your Full Legal Company Name: Describe what type of work your company does and where you operate? Address Phone Number: Year Company Established Do you have any other companies that need to be named in this policy? Please explain what type of work that company does     SECTION 2 - WHAT YOU DO AND WHERE Please check activities your company currently performs or plans to do in the near future: caisson work cranes owned or rented gas or oil field work raising or moving structures airport snow removal blasting or explosives demolition or wrecking bridges subways or railways shoring, underpinning or tunnelling   Last Year Current Year (estimate) Sales - Canadian Sales - Not Canadian Payroll - Canadian Payroll - Not Canadian % of Sales Sublet   Please Split your Sales as Follows - Percentage is Fine Commercial Residential Industrial     SECTION 3 - THE PEOPLE THAT HELP YOU - EMPLOYEES   Total Number of Employees Full Time Part Time Canadian US or Foreign Do you offer Health Care Benefits? Are all employees covered by Workers Compensation?     SECTION 4 - THE COMPANIES THAT HELP YOU - SUBCONTRACTORS Describe what type of work you typically subcontract Percentage of annual sales sublet in a typical year: Are certificates of insurance obtained from all subcontrators showing liability insurance of at least $2 million   SECTION 5 - YOUR STUFF AND WHERE YOU KEEP IT   Location 1 Location 2 Location 3 Location 4 Full Address Operations at this location Owned or Leased? Year Built Upgrades to roof, hvac, electrical Sq. Ft you own/rent/use What companies are your neighbours? Type of Heating? Air Conditioning? Sprinklers? Connected to Central? Hydrant Protected? Distance to Firehall? Number of Fire Extinguishers Burglar Alarm? Smoke Detectors? Value of Building Stock Value Office Furnishings, supplies etc. Number of printers, number of desktops, number of laptops, network? Any large outside tanks or below ground tanks?   SECTION 6 - WHAT EQUIPMENT YOU HAVE AND WHERE YOU KEEP IT EQUIPMENT   If you eventually accept our quote, before we can bind coverage we will need a list of your equipment detailing type, age, make, model and serial number and our course value. HOW TO VALUE YOUR EQUIPMENT NEWER THAN 2 YEARS - the value should be based on the full cost to replace the item with a similar new one OLDER THAN 2 YEARS The value should be based on the cost to replace it with a used one of similar age and condition WHAT IS THE DIFFERENCE BETWEEN TOOLS AND EQUIPMENT? Tools would be things such as hand tools , hammers, generators, drills etc. Equipment would include dozers, excavators, pavers, loaders, cranes, fork lifts Total Value of OWNED contractors equipment Total Value of OWNED tools How much did you spend last year on rental or equipment short term lease What was the value of the most expensive of those rented or short term leased items? Where is that equipment kept when not in use? Indoors or Out? Fenced if out? Will your owned equipment be rented or loaned to others? Do you use any theft protection measures on your equipment?   SECTION 7 - DOCUMENTS WE WILL ALSO NEED YOU TO EITHER ATTACH HERE OR EMAIL TO US   The summary pages of your existing insurance package (feel free to remove pricing as we are concerned with ensuring you have an apples to apples quote and to ensure you are not missing any coverage. Your existing auto policy and list of drivers (with license numbers) A list of any claims on any of your insurance policies within the past 5 years.