Does applicant own, operate or lease aircraft/watercraft?
Do/Have past, present or discontinued operations involve(d), storing, treating, discharging, applying, disposing or transporting of hazardous material?
Any work performed underground or above 15 feet?
Any work performed on barges, vessels, docks, bridges over water?
Is applicant engaged in any other type of business?
Are sub-contractors used?
Any work sublet without certificates of insurance?
If yes, payroll for this work must be included in the rating information
Is a written safety program in operation?
Any group transportation provided?
Any employees under 16 or over 60 years of age?
Any seasonal employees?
Is there any volunteer or donated labor?
Any Employees with Physical handicaps?
Do Employees travel out of state?
Are atheltic teams sponsored?
Are physicals required after offers of employment are made?
Any other insurance with this insurer?
Any prior coverage declined/cancelled/non-renewed in the last three years?
Are employee health plans provided?
Do any employees perform work for other businesses or subsidiaries?
Do you lease employees to or from other employers?
Do any employees predominately work at home?
Any tax liens or bankruptcy within the last 5 years?
Any undisputed and unpaid workers compensation premium due from you or any commonly managed or owned enterprises?
has the insured had any lapse in workers compensation coverage?
Have employees been working without workers compensation coverage?
Is the insured aware of any claims/losses in the last 4 years?
Any work or locations outside of the state (mailing address state)?
Any employees travel over 200 miles?
Is this a newly established business?
