g. Projects:
Current or Planned Projects Cost of Project Duration of Project
2. Liability Controls:
a. Does applicant use a written contract with customers? ........................................................................ Yes No
If no, explain when not required:
b. Does applicant use a written contract with subcontractors? ................................................................. Yes No
If no, explain when not required:
c. Do applicant’s contracts contain a hold harmless agreement in applicant’s favor? ............................. Yes No
d. Does applicant obtain certificates of insurance from all subcontractors? ............................................. Yes No
If yes, minimum limits required: $
e. Is applicant added as an additional insured on the subcontractors’ liability policies? .......................... Yes No
f. Does applicant have Workers’ Compensation coverage in force? ....................................................... Yes No
g. Does applicant provide architectural or engineering design services? ................................................. Yes No
h. Is applicant a construction/project manager or consultant? .................................................................. Yes No
i. Has applicant been involved in any claims involving construction defects? ......................................... Yes No
3. What is the average height of towers serviced?
4. What is the maximum height of towers serviced?
5. Any work on towers located on buildings? ............................................................................................ Yes No
If yes, explain:
6. Does applicant do any tower erection?................................................................................................... Yes No
If yes, please answer the following questions:
Average height of towers: Maximum height of towers erected:
Number of towers erected on buildings:
Number of towers erected per year:
7. Does applicant have written safety procedures for all employees and subcontractors? ................. Yes No
Do employees use safety harnesses?......................................................................................................... Yes No
Are underground utilities marked? ............................................................................................................... Yes No
8. Does applicant do any excavation work? ............................................................................................... Yes No
If yes, please complete the Excavators and Grading of Land Supplemental Application.
9. Does applicant do any welding work? .................................................................................................... Yes No
If yes, please complete the Welding, Brazing and Cutting General Liability Supplemental Application.
10. For tower owners:
Height of tower? Feet
GLS-SUPP-3g (7-13) Page 2 of 3