Janitorial Services Application (Complete) This application may feel long but it will provide all of the information our underwriters need in order to give an accurate quote that you can bind when you're ready. Step 1 of 6 16% Business InformationBusiness Name (include DBA) Organization TypeIndividualCorporationPartnershipLLCOtherAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Name* Phone*Email* Website OperationsDescription of Operations*Please describe the scope of the operation, what is the primary type of work that is performed?What year did the business start?* How many years at the current location?* Will any residences be cleaned during the policy term?* Yes No Will any offices, office dwellings or common areas of apartments, townhomes, condos, multi-family dwellings be cleaned during the policy term?* Yes No Will any mercantile locations (including retail stores, restaurants, theaters, arcades or banks) be cleaned during the policy term?* Yes No If Yes, will work be performed at mercantile locations when they are open for business or accessible to the general public? Yes No Will any other commercial buildings be cleaned during the policy term?* Yes No Liability CoverageRequested Occurrence Limit* $100,000 / $200,000 $300,000 / $600,000 $500,000 / $1,000,000 $1,000,000 / $2,000,000 How many full-time workers? (include owner, employees and those whose wages are reported on 1099)*Please enter a number from 1 to 100.Full-time is considered 30 hours or more per weekHow many part-time workers? (include owner, employees and those whose wages are reported on 1099)*Please enter a number from 0 to 100.Part-time is considered 29 hours or less per weekWhat are the projected total annual receipts?*Please enter a number from 0 to 1000000.Are independent contractors utilized? Yes No If Yes, what are the projected total annual costs?Please enter a number from 0 to 1000000. Optional CoveragesAdd Independent Contractors coverage?* Yes No Add Voluntary Property Damage Extension? (each occurrence $5,000, aggregate $25,000) Yes No This provides coverage for property that is damaged while in the care, custody, or control of the insured or their workers.Add Employee Theft of Customer's Property?* Yes No If Yes, what is the limit requested?Please enter a number from 5000 to 100000.Available in increments of $5,000, up to $100,000Add Blanket Additional Insured coverage?* Yes No Add Inland Marine coverage for equipment, lost keys and rental reimbursement?* Yes No Includes: Contractor's Equipment Floater (Blanket $10K, Any One item $2,500, Ded $500), Rental Reimbursement (Per Day $250, Any One Loss $5,000), Lost Key Coverage ($25,000 limit)Add "Waiver of Transfer of Rights of Recovery Against Other to Us"?* Yes No If Yes, how many people or organizations needed?Please enter a number from 1 to 50. Loss InformationHave there been any general liability and/or assault and battery losses in the last three years?* Yes No If “Yes,” provide the following information on each claim:-Coverage Type (Property/Liability) -Assault/Battery? (Yes/No) -Date of Loss -Description of Loss and Preventative Measures since implemented -$ Paid -$ Reserved -Open or Closed Eligibility CriteriaDo any of the following apply? Are more than 50 percent of sales generated from operations involving landscaping, lawn maintenance, carpet cleaning, interior painting and window cleaning (combined)? Are more than 50 percent of the total operations dedicated to floor waxing? Are there any operations involving insurance claim response, water removal/extraction, mold remediation, hood/duct cleaning, pressure washing or security? Are there any operations that include “handyman” services, such as electrical, plumbing or carpentry? Are there any operations that include the handling of infectious waste or hazardous material? Are there any operations within auto repair shops, car washes, machine shops, warehouses, manufacturing or industrial facilities (other than cleaning offices within such locations), hotels, college dormitories or schools? Are there any past, pending or planned foreclosure and/or bankruptcy or judgment for unpaid taxes against the named insured or any officer, partner, member or owner, individually within the past five years? Do any operations involve construction debris removal? Do any operations involve street cleaning requiring the use of heavy equipment? Do operations include cleaning of locations (other than personal residences) open 24 hours per day? Has insurance coverage been cancelled or non-renewed in the past three years? Is the annual cost for subcontractors more than 25 percent of the total annual receipts?