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Will you or do you perform or subcontract any work involving the following: blasting operations, <br />hazardous waste, asbestos, mold, PCBs, oil Delds, dams/levees, bridges, quarries, railroads, earthquake <br />retroDtting, fuel tanks, pipelines, or foundation repair? <br />If "Yes", please explain: <br />Yes No <br />Will you or do you perform or subcontract any work involving the following: medical facilities (including <br />new construction), hospitals (including new construction), churches or other house of worship, <br />museums, historic buildings, airports, schools/playgrounds/recreational facilities (including new <br />construction)? <br />If "Yes", please explain: <br />Yes No <br />Will you perform structural work?Yes No <br />Will you perform work in new tract home developments of 25 or more units?Yes No <br />If "Yes", please explain: <br />Will any of your work involve the construction of or be for new condominiums/townhouses/multi-unit <br />residences?: <br />Yes No <br />Will you perform repair only for individual unit owners of condominiums/townhouses/multi-unit <br />residences?: <br />Yes No <br />CURRENT EXPOSURES <br />Estimated Total Gross Receipts: $900,000 <br />Estimated Sub Contracting Costs: $125,000 <br />Estimated Material Costs: $0 <br />Estimated Total Payroll: 110k-150k <br />Number of Field Employees*: Owner + 4 <br />* For purposes of this application, "Employee" is deDned as an individual working for you (the applicant), which receives a W-2 tax form or you withhold & <br />pay employment related taxes for that individual. <br />WORK PERFORMED <br />Complete Descriptions of operations that for which you are currently applying for insurance: <br />Installs gypsum wall board including nonstructural metal framing members, taping and texturing. Drop ceiling and <br />acoustical ceiling install and repair. <br />Percentage of Residential work performed: 80% <br />Percentage of Commercial work performed: 20% <br />Percentage of New (Ground Up) work performed: 10% <br />Percentage of Remodel/Service/Repair work performed: 90% <br />Maximum # of Interior Stories: 2 <br />Maximum # of Exterior Stories: 0 <br />Maximum Exterior Depth Below Grade in Feet: 0 <br />Will you perform OCIP (Wrap-up) work: Yes No <br />If "Yes", what are the estimated receipts for work covered separately under OCIP/Wrap-up: <br />Estimated Receipts for non-Wrap/OCIP: <br />Number of losses in the last 5 years: 0 <br />WORK EXPERIENCE <br />In <br />s <br />u <br />r <br />a <br />n <br />c <br />e <br /> <br />A <br />p <br />p <br />l <br />i <br />c <br />a <br />t <br />i <br />o <br />n <br /> <br />Applicant <br />Page 2 of 6 <br />3632609 <br /> <br />0028468257P2 <br />Document Ref: WWZGI-C9ON9-3YW3U-DDXRG Page 2 of 28 <br />Docusign Envelope ID: C32ED128-E8C0-4517-B42B-471D21968944