MARKET SCOUT CONTRACTORS QUESTIONNAIRE (complete in addition to an Acord application) 1. Applicant:

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1 1. Applicant: 2. Type of all work performed by or for applicant (check You if performed by applicant and Subs if performed by subcontractors and both if done by both): Air Condition Systems Installation, Servicing or Repair Airport Runway or Warming Apron-paving/repaving/surfacing/resurfacing Alarm Systems Installation, Servicing or Repair Antenna Installation on cell phone or other type towers Appliances-Commercial-Installation, Servicing or Repair Appliances-Household Type-Installation, Servicing or Repair Blasting Operations or other use of Explosives or Explosive Devices Boring for communication lines, electrical lines, piping or cable lines Bridge Construction Bridge Inspection Bridge Paving or Repaving Buildings-raising or moving Cable Installation (pole to pole or pole to structure) Cable Installation (underground) Carpentry-Interior Carpentry-Framing Ceiling or Wall Installation-Metal Cleaning Outside Surfaces of Buildings (using water, steam or laser beams) Communication Equipment Installation-Industrial or Commercial Concrete Construction-Driveways, Sidewalks or Parking Concrete Flatwork-Foundation Slabs, Patios, etc Concrete Construction-Not Otherwise Shown Concrete Pumping Construction Consultant Construction Managment (acting as a construction manager) Contractors Equipment Rented to Others-Cranes or Similar Type Equipment Contractors Equipment Rented to Others-Backhoes, Dozers, Tractors, etc Contractors Equipment Rented to Others-Not Otherwise Shown Contractors Equipment Rented to Others-Scaffolding, Man Lifts, etc Dam, Levee or Dike Construction Debris Removal-Construction Site Developer acting as their own general contractor (hire and supervise all subs themselves) Developer subbing all construction to an independent general contractor Door or Window Installation-Metal Door or Window Installation-Wood Drywall or Wallboard Installation Electric or Power Line Construction Electrical Work-within buildings Excavation or Trenching Exterior Insulation and Finish Systems (EIFS, known as synthetic stucco )- Application, Installation, Use or Sale Fence Erection Fire Extinguishers-Servicing, Filling or Testing Fire Suppression Systems over cooking surfaces Fire Sprinkler Systems within buildings Fireproofing-structures Floor Covering Installation-carpet Ed. 08/02 1

2 Floor Covering Installation-not carpets, rugs, ceramic or stone tiles Floor Covering Installation-not ceramic tile or stone Floor Waxing Foundation Repair Furniture or Fixtures Installation in Offices or Stores-Metal or Wood Gas Mains or Connections Construction General Contractor Grading of Land-Site Preparation for Residential Tracts Grading of Land-Not Otherwise Shown Handyman-small repairs such as carpentry, painting, etc of a general nature Hazardous Material Abatement, Containment, Remediation or Removal Heating/Air Conditioning Systems Installation, Servicing or Repair House Furnishings Installation Insulation Work-Mineral Insulation Work-Organic Insulation Work-Plastic Janitorial Services Landscape Gardening Lawn Care Services Masonry Metal Erection-Decorative or Artistic Metal Erection-Nonstructural Metal Erection-Structural Office Machines or Appliances-Installation, Servicing or Repair Painting-Interior Painting-Exterior Paperhanging Pile Driving Pipeline Construction Plastering or Stucco Work Plumbing-Commercial or Industrial Plumbing-Residential Prefabricated Building Erection Remodeling of Existing Structures Renovating-Outside Surfaces of Buildings Restoration work due to fire, water, quake or other such damage Rigging Roofing-Commercial or Industrial Roofing-Residential Salvage Operations Sandblasting Seismic Repair or rehabilitation work Seismic Retrofitting or Structural work Septic Tank Systems -Cleaning Septic Tank Systems -Installation, Servicing or Repair Sewer Cleaning Sewer Mains or Connections Construction Sheet Metal Work-Outside Sheet Metal Work-Shop Only Siding Installation Sign Erection, Installation or Repair Sign Painting or Lettering-Inside of Buildings Sign Painting or Lettering-On Buildings or Structures Site Preparation (residential) Ed. 08/02 2

3 Site Preparation (commercial or industrial) Snow or Ice Removal Solar Energy Installation, Servicing or Repair Steam Pipe or Boiler Insulation Street Cleaning Street or Road Construction or Reconstruction Street or Road Paving or Repaving, Surfacing or Resurfacing or Scraping Swimming Pool Installation or Repair-Above Ground Pools Swimming Pool Installation or Repair-Below Ground Pools Swimming Pool Servicing Tank Installation-Above Ground Tank Installation-Below Ground Telephone, Telegraph or Cable TV Line Construction Television or Radio Set Installation or Repair Tile, Stone, Marble, Mosaic or Terrazzo Work-Interior Underpinning Buildings or Structures Water Mains or Connections Construction Waterproofing-By Pressure Waterproofing-By Trowel-Exterior Waterproofing-By Trowel-Interior Waterproofing-Not Otherwise Shown Waxing of Floors in Retail Stores Welding or Cutting-Shop Only Welding or Cutting-Not Otherwise Shown Window Cleaning Wrecking-Building or Structures Other (explain): 3. Is applicant involved (performs work or has work performed for him) on any of the following (check all applicable boxes): Apartments-new construction Apartments-Repair or Servicing on existing complexes Commercial Buildings (not habitational)-new construction Commercial Buildings (not habitational)-repair or Servicing on existing buildings Commercial Buildings (habitational)-new construction Commercial Buildings (habitational)-repair or Servicing on existing buildings Condominium (residential)-new construction Condominium (residential)-repair or Servicing on existing complexes Dwellings-new construction Dwellings-Repair or Servicing on existing homes Industrial Buildings-new construction Industrial Buildings-Repair or Servicing on existing buildings Townhomes-new construction Townhomes-Repair or Servicing on existing complexes Oil or Gas Fields Oil or Gas Refineries Ships or Watercraft of any kind Offshore Buildings or Structures 1 to 3 stories high Buildings or Structures 4 to 5 stories high Buildings or Structures 5 to 7 stories high Buildings or Structures 8 to 10 stories high Buildings or Structures over 10 stories Pipelines Ed. 08/02 3

4 4. If the answer is yes to new construction on apartments, condo s, dwellings or townhomes in Item #3 then provide maximum number of living units in any one project, development, complex or planned unit development within the past 10 years or anticipated within the next 12 months: 5. Does applicant use any of the following (check all applicable boxes): Yes No Casual Labor (not treated as employees) Leased Employees Subcontractors 6. Advise on use of subcontractors as follows (check all applicable boxes): Requires written agreement with all subs? Written agreement contains indemnity provision indemnifying applicant by subcontractors? Applicant requires a GL cert from all subs prior to them entering the job site? Applicant is named as an additional insured on the subcontractors GL policy? Applicant requires minimum GL limits from subs of: $1,000,000 $500,000 $300,000 $100,000 No set limits required Applicant requires subs to carry products-completed operations coverage? Applicant requires the following additional insured endorsement from subs: CG 2020 (11/85) CG 2010 (03/97) CG 2010 (10/01) Not specific Other- 7. Does applicant carry workers compensation on all of their own employees? Yes No 8. Show gross sales for each of the past 5 years plus estimated for next 12 months: 9. Show gross subcontract cost for past year and estimated for next 12 months: 10. GL Premium for past 3 years: Year $ Year $ Year $ 11. If applicant remodels existing structures, do they do room or building additions? Yes No 12. If applicant installs (or has installed for them) roofs of any kind, then complete the following: a. New Roofs % Re-roofs % Repair/Patch Work % b. Pitched/Sloped Roofs % Flat Roofs % c. List type of roofing materials used & % for each; d. Hot Tar used (by applicant or by subs)? Yes No If yes, % of jobs? % e. Open flame or torch applied to roofing materials while on roof? Yes No f. Does applicant install any type of elastomer roof coverings? Yes No Ed. 08/02 4

5 12. Remarks or Comments about this applicant: Date: Applicant: (Signature) Applicant: (Print or Type) Date: Producer: (Signature) Producer: (Print or Type) Ed. 08/02 5

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