Thank you! NEXT: PLEASE FILL OUT THE SUPPLEMENTARY APPLICATION BELOW CONTRACTOR’S SUPPLEMENTAL APPLICATIONPlease enable JavaScript in your browser to complete this form.APPLICANT INFORMATION:Applicant’s Name:Doing Business as:Name *FirstLastEmail *Title:Mailing AddressCityStateZipLocation AddressCityStateZipPhone NumberExt.Website1. Time in business:Years of experience:Licensed?YESNOYear of license:License #:Kind of License:Any previous/current license in another other state?YESNOIf so, list state(s):2. Percentage of Operations:General ContractorConstruction ManagerSubcontractorDeveloperWith Penalty Clause (for a fee only)3. Are there any other operations owned, operated, or managed by you?YESNOPlease explain:Is coverage in place elsewhere for these operations?YESNO4. Does any of your construction management work involve supervision of subs whose contracts and payments are not directly under your control?YESNOPlease explain:5. Radius of operations from main location:States worked in:6. Payroll of owners, officer, and partners active at job sites or performing supervisory duties$Payroll of employees other than owners, officers, partners, and clerical$Cost of leased, temporary, staffing service, casual labor (if not included above)$Total payroll$7. Do you employ any licensed architects, surveyors, engineers, Real Estate agents or brokers? YESNO8. Do you have any prior or planned jobs covered under “wrap-up” or OCP policies?YESNOPlease explain:9. List the percentage of work you have done or plan to do in the following categories:Overall operations: CommercialPublic WorksResidential OtherIF Other (Explain):Commercial:Newor RemodelIndustrialInstitutionalMercantileOfficeRemodeling – NonstructuralRemodeling – StructuralOther:Residential:Newor RemodelApartmentsCondominiums/TownhousesCustom Homes Tract HomesRemodeling – StructuralRemodeling – NonstructuralOther:Have you ever been or are currently involved in any residential project exceeding twenty (20) homes/units?YESNO10. SUBCONTRACTORSDo you obtain Certificates of Insurance for GL and WC from all subcontractors?YESNOWhat are the minimum General Liability limits you require?Are written contracts obtained from all subcontractors?YESNODo all contracts contain a Hold Harmless clause in your favor?YESNOAre you named as an Additional Insured on all subcontractor policies?YESNODo you normally use the same subcontractors?YESNODo you use any casual labor?YESNODo you use any leased employees? If yes, provide copy of contractYESNOAre you responsible for providing benefits, Worker’s Compensation for these employees?YESNOWhat percentage of your work do you sub out?Do you carry Worker’s Compensation insurance?YESNO11. Please provide your gross sales for each of the 5 past years and an estimate for the next 12 months:5th prior year5th prior year : PayrollPayroll $5th prior year : ReceiptsReceipts $5th prior year : Subcontractors CostSubcontractors Cost $4th prior year4th prior year : PayrollPayroll $4th prior year : ReceiptsReceipts $4th prior year : Subcontractors CostSubcontractors Cost $3rd prior year3rd prior year : PayrollPayroll $3rd prior year : ReceiptsReceipts $3rd prior year : Subcontractors CostSubcontractors Cost $2nd prior year2nd prior year : PayrollPayroll $2nd prior year : ReceiptsReceipts $2nd prior year : Subcontractors CostSubcontractors Cost $Last yearLast year : PayrollPayroll $Last year : ReceiptsReceipts $Last year : Subcontractors CostSubcontractors Cost $Projected next 12 monthsProjected next 12 months : PayrollPayroll $Projected next 12 months : ReceiptsReceipts $Projected next 12 months : Subcontractors CostSubcontractors Cost $12. Describe your three largest projects currently underway or planned for the next year, including values:Start DateStart DateEnd DateEnd DateValueValueDescriptionDescriptionStart DateStart DateEnd DateEnd DateValueValueDescriptionDescriptionStart DateStart DateEnd DateEnd DateValueValueDescriptionDescription13. Describe your four largest projects over the past five years, including values:13. Describe your four largest projects over the past five years, including values:Year CompletedYear CompletedValueValueDescriptionDescriptionYear CompletedYear CompletedValueValueDescriptionDescriptionYear CompletedYear CompletedValueValueDescriptionDescriptionYear CompletedYear CompletedValueValueDescriptionDescriptionYear CompletedYear CompletedValueValueDescriptionDescription14. Please provide the dollar value of an average completed job (including all materials, equipment, and labor):15. How many additional insured endorsements do you anticipate needing in the next year?16. Is there any equipment rental to others?YESNOIf yes, sales/receipts:List equipment:Attach a copy of the contract.17. Do you lease mobile equipment?YESNOWith operators?YESNOType of equipment:Do you use cranes?YESNOMaximum length of boom: 18. Do you or have you performed repairs of fire damage, water damage, or mold damage?YESNO19. Do you use explosives?YESNOIf yes, please explain:20. Any flammables stored on site?YESNOIn approved containers?YESNOIf yes, please explain:21. Have you done or do you plan any work performed for:RefineriesYESNOGas StationsYESNOChemical PlantsYESNOAirportsYESNORailroadsYESNOHospitalsYESNOPublic UtilitiesYESNOPlease explain:22. Have you done or do you plan any project involving:CaissonsYESNORetaining WallsYESNOUnderpinningYESNOPiersYESNOShoringYESNOOther structural engineering?YESNOPlease explain: 23. Have you in the past or do you plan any work to be above two stories in height?YESNOPercentage:What is the maximum height?Please explain: 24. Have you in the past or do you plan any work to be performed below ground level?YESNOPercentage:What is the maximum height?Please explain:25. Have you in the past or do you plan any work on hillsides, hilltops, slopes, or landfills?YESNOMaximum degree of slope:26. Have you in the past or do you plan any repair, replace or new roofs?YESNOPercentage of heat applications: %Percentage of membrane roofing: %Please explain:27. In the past three years, have you been fired or replaced on a job in progress?YESNOHave you replaced another contractor on a job in progress?YESNOPlease explain:Were there any claims, losses, or suits against you in the past five years?YESNOAre there any claims or legal actions pending against any of the entities named in the application?YESNODo any of the entities named in the application have knowledge of any pre-existing act, omission, event, condition, or damage to any person or property that may potentially give rise to any future claim or legal action?YESNOHave you been accused of faulty construction in the past five years?YESNOHave you been accused of breaching a contract in the past five years?YESNO28. Complete the following table (Subbed cost $ and Employee Payroll $) as applicable:IF NOT applicable : leave it blankAbatement/Asbestos, Lead, Environmental Cleanup:.Abatement/Asbestos, Lead, Environmental Cleanup: Subbed Cost $Subbed Cost $Abatement/Asbestos, Lead, Environmental Cleanup : Employee Payroll $Employee Payroll $Air Conditioning/Heating.Air Conditioning/Heating : Subbed Cost $Subbed Cost $Air Conditioning/Heating : Employee Payroll $Employee Payroll $Alarm Systems:.Alarm Systems : Subbed Cost $Subbed Cost $Alarm Systems : Employee Payroll $Employee Payroll $Blasting:.Blasting : Subbed Cost $Subbed Cost $Blasting : Employee Payroll $Employee Payroll $Boiler Installation :.Boiler Installation : Subbed Cost $Subbed Cost $Boiler Installation : Employee Payroll $Employee Payroll $Caisson or Cofferdam Work/Dam :.Caisson or Cofferdam Work/Dam : Subbed Cost $Subbed Cost $Caisson or Cofferdam Work/Dam : Employee Payroll $Employee Payroll $Carpentry – Dwellings : .Carpentry – Dwellings : Subbed Cost $Subbed Cost $Carpentry – Dwellings : Employee Payroll $Employee Payroll $Carpentry – Interior :.Carpentry – Interior : Subbed Cost $Subbed Cost $Carpentry – Interior : Employee Payroll $Employee Payroll $Carpentry – Other : .Carpentry – Other : Subbed Cost $Subbed Cost $Carpentry – Other : Employee Payroll $Employee Payroll $Concrete Construction/Repair – Driveways, Sidewalks or Parking Areas :.Concrete Construction/Repair – Driveways, Sidewalks or Parking Areas : Subbed Cost $Subbed Cost $Concrete Construction/Repair – Driveways, Sidewalks or Parking Areas : Employee Payroll $ (copy)Employee Payroll $Concrete Construction/Repair – Foundations, Flat Work / Tiltup Work :.Concrete Construction/Repair – Foundations, Flat Work / Tiltup Work : Subbed Cost $Subbed Cost $Concrete Construction/Repair – Foundations, Flat Work / Tiltup Work : Employee Payroll $Employee Payroll $Drywall/Wallboard Installation :.Drywall/Wallboard Installation : Subbed Cost $Subbed Cost $Drilling : Employee Payroll $Employee Payroll $ Maintenance, New for: Earthquake Reinforcement :.Earthquake Reinforcement : Subbed Cost $Subbed Cost $Earthquake Reinforcement : Employee Payroll $Employee Payroll $Electrical Work – Within Buildings :.Electrical Work – Within Buildings : Subbed Cost $Subbed Cost $Electrical Work – Within Buildings : Employee Payroll $Employee Payroll $Electrical Work – Other :.Electrical Work – Other : Subbed Cost $Subbed Cost $Electrical Work – Other : Employee Payroll $Employee Payroll $Escalator/Elevator – Install, Maintenance, Repair : .Escalator/Elevator – Install, Maintenance, Repair : Subbed Cost $Subbed Cost $Escalator/Elevator – Install, Maintenance, Repair : Employee Payroll $Employee Payroll $Excavating/Grading of Land :.Excavating/Grading of Land : Subbed Cost $Subbed Cost $Excavating/Grading of Land : Employee Payroll $Employee Payroll $Fireproofing :.Fireproofing : Subbed Cost $Subbed Cost $Fireproofing : Employee Payroll $Employee Payroll $Gas Mains/LPG Work :.Gas Mains/LPG Work : Subbed Cost $Subbed Cost $Gas Mains/LPG Work : Employee Payroll $Employee Payroll $Gas Pumps : .Gas Pumps : Subbed Cost $Subbed Cost $Gas Pumps : Employee Payroll $Employee Payroll $Insulation :.Insulation : Subbed Cost $Subbed Cost $Insulation : Employee Payroll $Employee Payroll $Masonry – (EIFS Work-synthetic stucco, retaining wall work) : .Masonry – (EIFS Work-synthetic stucco, retaining wall work) : Subbed Cost $Subbed Cost $Masonry – (EIFS Work-synthetic stucco, retaining wall work) : Employee Payroll $Employee Payroll $Mechanical :.Mechanical : Subbed Cost $Subbed Cost $Mechanical : Employee Payroll $Employee Payroll $Millwright/Industrial Machinery :.Millwright/Industrial Machinery : Subbed Cost $Subbed Cost $Millwright/Industrial Machinery : Employee Payroll $Employee Payroll $Painting : .Painting : Subbed Cost $Subbed Cost $Painting : Employee Payroll $Employee Payroll $Plastering :.Plastering : Subbed Cost $Subbed Cost $Plastering : Employee Payroll $Employee Payroll $Playground Equipment – Maintenance or Repair :.Playground Equipment – Maintenance or Repair : Subbed Cost $Subbed Cost $Playground Equipment – Maintenance or Repair : Employee Payroll $Employee Payroll $Pile Driving : .Pile Driving : Subbed Cost $Subbed Cost $Pile Driving : Employee Payroll $Employee Payroll $Plumbing – Residential :.Plumbing – Residential : Subbed Cost $Subbed Cost $Plumbing – Residential : Employee Payroll $Employee Payroll $Plumbing – Commercial:.Plumbing – Commercial : Subbed Cost $Subbed Cost $Plumbing – Commercial : Employee Payroll $Employee Payroll $Road, Highway, Bridge, Overpass :.Road, Highway, Bridge, Overpass : Subbed Cost $Subbed Cost $Road, Highway, Bridge, Overpass : Employee Payroll $Employee Payroll $Roofing – Residential : .Roofing – Residential : Subbed Cost $Subbed Cost $Roofing – Residential : Employee Payroll $Employee Payroll $Roofing – Commercial : .Roofing – Commercial : Subbed Cost $Subbed Cost $Roofing – Commercial : Employee Payroll $Employee Payroll $Seismic Work/Repair Describe: :.Seismic Work/Repair Describe : Subbed Cost $Subbed Cost $Seismic Work/Repair Describe : Employee Payroll $Employee Payroll $Sewer/Water Mains :.Sewer/Water Mains : Subbed Cost $Subbed Cost $Sewer/Water Mains : Employee Payroll $Employee Payroll $Sprinkler Installation (Buildings) :.Sprinkler Installation (Buildings) : Subbed Cost $Subbed Cost $Sprinkler Installation (Buildings) : Employee Payroll $Employee Payroll $Steel – Ornamental :.Steel – Ornamental : Subbed Cost $Subbed Cost $Steel – Ornamental : Employee Payroll $Employee Payroll $Steel – Structural :.Steel – Structural : Subbed Cost $Subbed Cost $Steel – Structural : Employee Payroll $Employee Payroll $Supervisory Only :.Supervisory Only : Subbed Cost $Subbed Cost $Supervisory Only : Employee Payroll $Employee Payroll $Swimming Pool Construction :.Swimming Pool Construction : Subbed Cost $Subbed Cost $Swimming Pool Construction : Employee Payroll $Employee Payroll $Traffic Signals/Controls Describe :.Traffic Signals/Controls Describe : Subbed Cost $Subbed Cost $Traffic Signals/Controls Describe : Employee Payroll $Employee Payroll $Tunneling :.Tunneling : Subbed Cost $Subbed Cost $Tunneling : Employee Payroll $Employee Payroll $Underground Tank Removal/Installation :.Underground Tank Removal/Installation : Subbed Cost $Subbed Cost $Underground Tank Removal/Installation : Employee Payroll $Employee Payroll $Waterproofing :.Waterproofing : Subbed Cost $Subbed Cost $Waterproofing : Employee Payroll $Employee Payroll $Wrecking/Demolition :.Wrecking/Demolition : Subbed Cost $Subbed Cost $Wrecking/Demolition : Employee Payroll $Employee Payroll $Submit5267
