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| COMPANY
INFORMATION |
| Your
Name |
|
| COMPANY
NAME |
|
| ADDRESS |
|
| CITY,
STATE, ZIP |
|
| PHONE
# |
|
| FAX
# |
|
| YOUR
EMAIL |
|
| COMPANY
WEB SITE |
http://
|
| CA
LICENSE # |
|
| CLASS |
|
| YRS.
IN BUSINESS |
|
| INSURANCE
HISTORY |
| CURRENT
INSURANCE CO. |
EXPIRES
|
| LAST
YEAR'S POLICY |
EXPIRED
|
| TWO
YEARS AGO POLICY |
EXPIRED
|
|
|
Please specify,
if not in list
|
| YOUR
WORK |
| MY
CONTRACTING FIELD IS: |
Please specify, if not in list
|
| NUMBER
OF FULL TIME EMPLOYEES |
|
| NUMBER
OF PART TIME EMPLOYEES |
|
| PERCENTAGE
OF RESIDENTAL AND COMMERCIAL WORK |
Percent
residential work:
%
Percent commercial
work:
% |
| PERCENT
REMODEL VS NEW CONSTRUCTION |
Percent
remodel/repair work:
%
Percent new construction
work:
% |
| CONDOMINIUM
WORK |
Do
you now or have you in the past ten (10) years, performed
any work on NEW condominiums or under contract to
Condo Associations?
Yes
No
Do you now or have
you in the past ten (10) years, performed any remodel
and/or repair work under contract to Condominium Associations?
Yes
No
Do you now or have
you in the past ten (10) years, performed any remodel
and/or repair work for individual condominium owners?
Yes
No
|
| FOUNDATION
WORK |
Do
you do any foundation work? Yes
No
If Yes, NEW foundations?
Yes
No
Foundation repair? Yes
No
|
| HILLSIDES,
SLOPES, AND OTHER TOPOGRAPHY |
Do
you now or in the past build on hillsides, slopes,
landfills, or subsidence areas?
Yes
No
If yes, degree of slope
|
| IF YOU DO
ROOFING WORK |
INDICATE
THE PERCENTAGES IN EACH OF THE FOLLOWING:
| TILE |
|
| COMPOSITION |
|
| FOAM
/ WATERPROOF |
|
| HOT
TAR |
|
| WOOD
SHAKE |
|
| COLD
BUILD-UP |
|
| TORCH
DOWN |
|
| SHINGLES |
|
| ROOF
TEAROFF |
|
| OTHER |
|
|
| PAST
CLAIMS |
HAVE
YOU HAD ANY CLAIMS WITHIN THE PAST 5 YEARS?
Yes
No
IF YES, WE'LL CALL FOR THE DETAILS...
|
| THE
VITAL INFORMATION |
| NEXT
12 MONTHS |
GROSS
RECEIPTS
PAYROLL W/O OWNER
SUBCONTRACT COSTS
|
| LAST
12 MONTHS |
GROSS
RECEIPTS
PAYROLL W/O OWNER
SUBCONTRACT COSTS
|
| |
|
Specific
information not found :
|
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YOU HEAR ABOUT US ? |
|
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