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Audit Submit Online
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Audit Submit Online
This is an audit for your policy to verify accuracy of information.
Company Name
*
Policy Number
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Detailed Description of Operations:
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# Of Employees (Excluding Owner)
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Gross Payroll (Excluding Owner) $
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Number of Projects or Homes Started:
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Number of Projects or Homes Completed:
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Gross Receipts:
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Please select the appropriate operations that describe your work:
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A/C Refrigeration
A/C System Installation
Appliance & Accessories Installation
Carpentry Exterior
Carpentry Interior
Cleaning (Outside Building)
Concrete (Flat)
Concrete Foundation
Drilling
Debris Removal
Door/Window Installation
Drywall
Electrical
Excavation
Fencing
Floor Covering Installation
Garage Door Installation
General Contractor New Residential
General Contractor New Commercial
Glass Installation/Glazing
Grading
Handyman
HVAC
Insulation
Janitorial
Landscape
Masonry
Metal Erection (Decoration Only)
Painting Interior
Painting Exterior
Plastering/Stucco
Plumbing
Pressure Washing
Remodel Contractor Residential
Remodel Contractor Commercial
Roofing
Septic Tank Install & Service
Sheet Metal
Siding and Decking
Street/Road Paving (Commercial)
Swimming Pool Cleaning
Swimming Pool Installation
Tile & Marble Installation
Tree Trimming
Water Drilling
Welding (Non-Structural Only)
Other:
To select multiple classes hold down the Ctrl key while selecting.
Other operations - please clarify:
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Excavation - please clarify how many feet down?
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Do you use Subcontractors?
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Yes
No
Dollar Amount of Work Subcontracted:
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What minimum General Liability limit is required?
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Do the subcontractor(s) provide certificates of insurance?
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Yes
No
Do you provide supervision for the subcontractors?
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Yes
No
Do you have a written contract agreement with the subcontractor(s)?
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Yes
No
If so, is there a “Hold Harmless” clause in your favor in the contract?
Yes
No
Do you always require subcontractor(s) to name you as additional insured?
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Yes
No
Type of Work & Job Operations
Percent of Remodeling / Service / Repair:
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Percent of New Construction:
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Percent of Commercial Construction:
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Percent of Residential Construction:
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Check all boxes that apply to your business:
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Condo
Track Homes
Commercial
Roofing
Town- Home
Single Family Homes
Industrial
Home Owners Association
Other Residential
Other, please specify:
Other, please specify:
*
***IMPORTANT*** PLEASE SUBMIT THE FOLLOWING REQUIRED DOCUMENTATION FOR THE POLICY TERM: Profit & Loss Statement ( ); OR Bank Statements ( ) These documents should summarize your revenue, costs and expenses incurred during the policy period.
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB.
Audit Completed by:
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Date:
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MM slash DD slash YYYY
Email address:
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Contractor’s License Number (If Applicable):
By submitting the audit, I am confirming that all information included is accurate, official and not forged.
I Agree
Comments
This field is for validation purposes and should be left unchanged.
2244 Faraday Ave #129
Carlsbad CA 92008
760.795.0021
(Phone)
760.795.0098
(Fax)
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