Navigators Applicant How many years of experience do you have in the contracting business Text7 Years in business of entities seeking coverage Date7_af_date fill_19 fill_18 fill_21 fill_20 fill_22 fill_23 fill_24 fill_25 fill_26 fill_29 fill_28 fill_30 fill_27 Do you use subcontractors Choice1 Choice2 Annual costs Percentage of your work subcontracted out undefined_2 undefined List the trades of the subcontractors you use and give the percentage of your work they perform Text1 Text5 Text3 Text6 undefined_4 undefined_3 Do you always collect certificates of insurance from subcontractors Text2 Text4 Do you always collect certificates of insurance from subcontractors? Choice3 Choice1 What minimum General Liability limit is required Do you always require subcontractors to name you as an additional insured? Choice2 Choice4 Do you have a standard formal written contract with subcontractors? Choice3 Choice1 undefined_1 Choice2 Choice4 Note: Choice1 Choice3 How long do you maintain records of the above documents OCIP Choice5 Choice6 Please explain States in which you operate undefined_5 undefined_6 undefined_8 undefined_7 undefined_9 undefined_10 Payroll of employees other than owners officers partners clerical undefined_11 undefined_12 fill_29 undefined_13 Date9_af_date Date8_af_date Text14 Text17 Date10_af_date Date11_af_date Text15 Text18 Text16 Text19 Date13_af_date Date12_af_date Date20_af_date Text28 Text24 Text29 Date21_af_date Text25 Text26 Date22_af_date Text30 Text31 Date23_af_date Text27 Dollar value of average job completed including all materials labor equipment How many new homes will you build as a general contractor in the next year What is the greatest number of new homes you have built in any one year How many additional insured endorsements do you anticipate needing in the next year Please explain page 2 Choice1 Choice2 Please explain_2 Are you a licensed architect or engineer? Choice3 Choice4 Do you have any operations other than contracting? Choice1 Choice2 In the past 3 years have you owned, Choice3 Choice4 Description Description_2 Condominiums Choice3 Choice1 4 Choice1 Choice2 Condominiums townhouses or lofts 1 Choice1 Choice2 5 Choice1 Choice2 Apartments 2 Choice1 Choice2 6 Choice1 Choice2 7 Choice1 Choice2 3 Choice1 Choice2 Description 1 9 Choice1 Choice2 Maximum degree of slope Description_3 10 Choice1 Choice2 Description_4 If retaining walls have been or will be built maximum height 11 Choice3 Choice4 Describe Percentage of operations 12 Choice5 Choice6 Maximum height If so what percentage Description_5 13 Choice7 Choice8 Maximum depth If so what percentage_2 Description_6 14 Choice9 Choice10 Description_7 15 Choice11 Choice12 16 Choice13 Choice14 Description_8 17 Choice15 Choice16 18 Choice1 Choice2 19 Choice3 Choice4 20 Choice5 Choice6 21 Choice7 Choice8 22 Choice9 Choice10 e 1 e 2 e 3 23 Choice11 Choice12 36 Choice13 Choice14 24 Choice13 Choice14 37 Choice2 Choice1 25 Choice2 Choice1 38 Choice1 Choice2 26 Choice1 Choice2 39 Choice1 Choice2 40 Choice1 Choice2 27 Choice1 Choice2 41 Choice1 Choice2 42 Choice1 Choice2 29 Choice1 Choice2 30 Choice13 Choice14 43 Choice2 Choice1 31 Choice2 Choice1 44 Choice1 Choice2 32 Choice1 Choice2 45 Choice1 Choice2 33 Choice1 Choice2 34 Choice13 Choice14 46 Choice2 Choice1 35 Choice2 Choice1 Explain any yes answers below and state whether performed by insured or subcontracted 1 Signature of ApplicantDate3_af_date Name and Title
