1099 Contractors Agreement

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					                                                             Contractor's Questionnaire



Mailing Address:

Physical Address:

Web Address:

Year's in Business:                                                    Year's Experience:
Description of Operations:

            Operation is (%)                                                                      Type of Work (%)
General Contractor                                                                  Developer
        Subcontractor                                                 Construction Manager
  Artisan Contractor                                                       W/Penalty Clause

                     Commercial           New:                                           Residential          New:
                                     Remodel:                                                            Remodel:

                                     Industrial                                                        Apartments
                                   Institutional                                   Condominiums/Townhomes
                                    Mercantile                                                    Custom Homes
                                         Office                                                      Tract Homes
                    Remodeling - Structural                                             Remodeling - Structural
               Remodeling - Nonstructural                                           Remodeling - Nonstructural
                                          Other                                                               Other

                                                                          Current Year             Previous Year            Two Years
                                                                          NEXT 12 MOS.                (07-08)              Ago (06-07)
Gross Annual Receipts:
Number of Owners:
Number of Direct Employees (W2 and 1099 ):
Estimated Annual payroll:
Cost of Insured Sub-Contractor's:
Cost of Uninsured Sub-Contractor's:

  * Uninsured subcontractors, independent contractors and 1099 employees are classified and rated as direct employees. If Certificates of
  Insurance are not obtained from subcontractors the cost of subcontracted work will be deemed as payroll on audit and charged accordingly.

Describe Equipment used in Operations:
  (Cranes/Cherry Pickers/Lifts - Maximum Height)
List five current or planned projects:
  Customer Name and Project Description:                                          Cost of Project     Duration of Project

List five largest jobs in the last 3 years:
  Customer Name and Project Description:                                          Cost of Project      Completed

 Indicate percent of work perfomed based on total operations of any of the following:
Airports                                                                       Masonry
Asbestos Removal                                                               Mechanical
Blasting                                                                       Municipality Work
Bridge Construction                                                            Peir or Wharf Const.
Boring                                                                         Pipeline
Boiler Inspection                                                              Plastering/Stucco
Bldg. - raising or moving                                                      Pollution Abatement
Cofferdam or Caisson work                                                      Railway
Dam/Reservoirs                                                                 Shoring/Underpinning
Demolition                                                                     Steel
Drilling                                                                       Steel (ornamental)
EFS or Related Work                                                            Stevedoring
Excavation                                                                     Street/Road
Equipment Rental to Others                                                     Sub Aqueous
Fire Suppression                                                               Subways
Gas/Water Mains                                                                Supervising Only
Grading                                                                        Tunnels
Landfills                                                                      Waterproofing
Lead Paint Removal                                                             Wrap-ups
Maintenance                                                                    Other (describe)
                                             Provide Estimated Payroll and Cost of Sub's
                                                    for each Trade Classification
                                                           Direct W2 & 1099       Cost of Insured       Cost of
                                              Class Code   Employee Payroll       Sub's (91583)     Uninsured Sub's
Abatement/Asbestos/Lead Clean Up
Air Conditioning Systems, Install/Repair       (91111)
Alarm Systems, Install/Repair                  (91127)
Advertising Sign Install - Outdoors            (90089)
Carpentry                                      (91342)
Concrete Const. - Foundations, Tiltup Work     (91560)
Concrete Construction - Driveways, Walks       (98215)
Debris Removal - Construction Site             (91629)
Door or Window Installation                    (91746)
Dry Wall or Wallboard Installation - Metal     (92338)
Electrical Work within buildings               (92478)
Electrical Work - Other
Grading of Land                                (95410)
Fence Erection                                 (94276)
Floor Covering                                 (94569)
Tile Work, Installation                        (99746)
Masonry Work                                   (97447)
Painting - Exterior                            (98304)
Painting - Interior                            (98305)
Plumbing - Commercial or Industrial            (98482)
Plumbing - Residential                         (98483)
Roofing - Commercial or Industrial             (98677)
Roofing - Residential                          (98678)
Siding Installation                            (98967)
Metal Erection - Ornamental                    (97650)
Metal Erection - Structural                    (15405)
Swimming Pool, Install/Service                 (99507)
Other   Executive Supervisor                   (91580)
Total:                                                     $                  -   $             -   $            -
Have you ever been involved in the new construction of tract houseing, row houses,
condominiums or townhouses?                                                                            Yes                    No
 If yes, what percentage of total revenue -

Have you performed original framing, window or door installation work on any condominiums,
townhouses or tract homes?                                                                             Yes                    No

Do you use a written contract with customers?                                                          Yes                    No
  If no, explain when not required
Do you obtain certificates of insurance from all subcontractors?                                       Yes                    No
  If yes, minimum limits required.
Do you use a written contract with subcontractors?                                                     Yes                    No
  If no, explain when not required
Do your contracts contain a hold harmless agreement in your favor?                                     Yes                    No

Are you added as Additional Insured on the subcontractor's liability policies?                         Yes                    No
Do you normally use the same subcontractors?                                                           Yes                    No
What percentage of your work do you sub out?
Do you provide Architectural or Engineering design services?                                           Yes                    No
  If Yes, explain

  Do you carry Errors & Omissions coverage for these services?                                         Yes                    No
Have you been involved in any claims involving construction defect?                                    Yes                    No
Do you install, service, repair or work with EIFS Systems?                                             Yes                    No
Do you use any type of scaffolding or lifts?                                                           Yes                    No
Have you done or do you plan any work performed for:
               Refineries:                                                            Gas Stations:
         Chemical Plants:                                                                  Airports:
                Railroads:                                                               Hospitals:
           Public Utilities:

           Please explain:

Have you done or do you plan any project involving:
                Caissons:                                                                     Piers:
          Retaining Walls:                                                                 Shoring:
            Underpinning:                                                                     Other Structural Engineering?

           Please explain:

Have you in the past or do you plan any work to be above two stories in hight?                         Yes                    No
              Percentage:                                                         Maximum Height:

Have you in the past or do you plan any repair, replace or new roofs?                                  Yes                    No
                  Percentage of heat applications:                                        Percentage of membrane roofing:

In the past three years, have you been fired or replaced on a job in progress?                         Yes                    No
Have you replaced another contractor on a job in progress?                                             Yes                    No
           Please Explain

Were there any claims, losses or suits against you in the past five years                              Yes                    No

Are there any claims or legal actions pending against any of the entities named in the application?    Yes                    No
Do 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?                                                                                 Yes                    No
Have you been accused of faulty construction in the past five years?                                   Yes                    No
Have you been accused of breaching a contract in the past five years?                                  Yes                    No

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