Exposure Questionnaire:
Act as a General Contractor?
Yes
No
Elevators, escalators, boilers?
Yes
No
Alarm systems?
Yes
No
Excavation / tunneling?
Yes
No
Any aircraft, railroad, watercraft or auto work?
Yes
No
Exposure to radioactive / nuclear material?
Yes
No
Any bridges, dams or sewer construction work?
Yes
No
Exterior work over 3 stories?
Yes
No
Any cell phone, water, gas, oil tank or tower work?
Yes
No
Fiber optic cable work?
Yes
No
Any herbicides or pesticides work?
Yes
No
Fire extinguisher systems?
Yes
No
Any out-of-state operations?
Yes
No
Have you ever been named in a construction defect suit?
Yes
No
Any prior losses in the last 5 years?
Yes
No
Mobile home or related work?
Yes
No
Any roofing or roof related work?
Yes
No
Mold / fungus remediation work?
Yes
No
Any work with cranes of any height, owned or leased?
Yes
No
Operated as an inspection or appraisal company?
Yes
No
Any work with LPG?
Yes
No
Ops involving discharge of fumes, acids or waste?
Yes
No
Asbestos abatement?
Yes
No
Prefab steel construction?
Yes
No
Blasting, demolition or any explosive materials used?
Yes
No
Rent, lease or repair equipment?
Yes
No
Chemical spraying / fumigating?
Yes
No
Tree or limb removal?
Yes
No
Coal, wood, waste or oil burning stoves?
Yes
No
Underpinning / foundation repair?
Yes
No
Digging more than 3 feel underground?
Yes
No
Waste removal?
Yes
No
Does applicant draw plans, designs or specifications?
Yes
No
Waxing floors in commercial buildings or stores?
Yes
No
Explain any Yes answers
Work involving medical and / or industrial equipment?
Yes
No
