13. What type of Additional Insured Endorsements are your required to produce:
a. Ongoing Operations Yes o No o
b. Ongoing Operations including Completed Operations Yes o No o
14. Have you ever performed work on hillsides, hill tops, slopes, landfill, or other subsidence areas, or do you
plan to in the future (other than non-structural work)? Yes o No o
a. If yes, please explain: __________________________
15. Have or will any of your projects involve caissons, cantilevers, piers, retaining walls, shoring, underpinning,
or other heavy structural engineering techniques? Yes o No o
a. If yes, please explain: __________________________
16. Do you or have you performed repairs of fire damage, water damage, or mold damage?
a. If yes, please explain: __________________________ Yes o No o
17. Do you perform work above two stories in height (other than interior remodeling)? Yes o No o
a. If yes, please explain: __________________________
18. Do you perform any work below ground level? Yes o No o
a. If yes, please explain: __________________________
19. Have you or will you perform work related to gas stations, refineries, chemical plants, airports, public
utilities, railroads, or hospitals? Yes o No o
a. If yes, please explain: __________________________
20. Note: the following questions apply regardless of whether you were at fault for a claim or incident, and
regardless of whether the claim or incident was covered by insurance. “Legal actions includes lawsuits,
mediation, and arbitration.
a. Have there been losses, claims, or legal actions brought against you in the past 5 years?
Yes o No o
b. Are there any claims or legal actions pending against you? Yes o No o
c. Do you have knowledge of any pre-existing act, omission, event, condition, or damages to any
person or property that may have potentially give rise to any future claim or legal action against any
entity named in the application? Yes o No o
d. Have you been accused of faulty construction in the past 5 years? Yes o No o
e. Have you been accused of breaching a contract in the past 5 years? Yes o No o
f. If yes to any, please explain: __________________________
21. Have you filed for bankruptcy in the past 5 years? Yes o No o
