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Before beginning this application, please have your Loss Run Report ordered. Until we receive a copy of the report, we cannot issue a quote. Please see the instructions for how to do this here.

1. Applicant Name:
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2. Applicant Email:
3. Applicant Phone Number:
4. Company Name:
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5. Address:
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6. Website Address:
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7. Are you an NRCA (National Roofing Contractor Association) member?
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Yes
No
8. Percentage Of Roofing Operations Receipts To Total Receipts:
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9. Contractor's License Number(s):
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10. Have you ever worked in, or do you anticipate working in New York State?
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Yes
No
11. Have you ever worked in, or do you anticipate working in Colorado?
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Yes
No
12. Please list all states that you perform work in:
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13. List all other business names and licenses applicant has used in the past 10 years:
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14. Description of Operations:
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15. Does applicant currently own or operate any other business?
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Yes
No
If yes, please provide the name of the business and percentage of ownership:
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Description of Operations:
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16. What percentage of your current operation is general contracting work?
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17. What percentage of your current operation is subcontracting work?
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18. What percentage of your current operation is general construction manager work?
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19. Projection of Gross Receipts for the Upcoming Year:
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20. Estimated Gross Receipts for the Year Just Completed:
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21. Gross Receipts for the First Prior Year:
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22. Gross Receipts for the Second Prior Year:
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23. Gross Receipts for the Third Prior Year:
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24. Projected Payroll for the Upcoming Year:
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25. Estimated Payroll for the Year Just Completed:
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26. Actual Payroll for the First Prior Year:
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27. Actual Payroll for the Second Prior Year:
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28. Actual Payroll for the Third Prior Year:
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29. Projected Sub Contractor Costs for the Upcoming Year:
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30. Estimated Sub Contract Costs for the Year Just Completed:
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31. Actual Sub Contract Costs for the First Prior Year:
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32. Actual Sub Contract Costs for the Second Prior Year:
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33. Actual Sub Contractor Costs for the Third Prior Year:
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34. What percentage of your work is residential?
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35. What percentage of your work is commercial?
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36. What percentage of your work is industrial?
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37. What percentage of you work is other?
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38. What percentage of your work is asphalt shingle roofing?
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39. What percentage of your work is wood/shake shingle roofing?
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40. What percentage of your work is slate roofing?
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41. What percentage of your work is tile roofing?
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42. What percentage of your work is metal roofing?
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43. What percentage of your work is polyurethane foam roofing?
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44. What percentage of your work is hot tar roofing?
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45. What percentage of your work is on pitched roofs?
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46. What percentage of your work is on low slope roofs?
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47. What percentage of work is on flat roofs?
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48. What percentage of your work is torch down?
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49. What percentage of your work is hot air welding?
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50. What percentage of your work is modified bitumen? (Hot)
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51. What percentage of work is modified bitumen? (Cold)
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52. What percentage of your work is EPDM? (Hot)
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53. What percentage of your work is EPDM? (Cold)
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54. What percentage of your work is residential new construction?
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55. What percentage of your work is commercial new construction?
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56. What percentage of your work is re-roofing?
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57. What percentage of your work is roof repair?
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58. Will your upcoming work involve new construction on condominiums?
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Yes
No
If yes, what is the percentage of total roofing operations?
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59. Will your upcoming work involve repair or remodel work on condominiums?
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Yes
No
60. Will your upcoming work involve new construction on tract home development?
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Yes
No
If yes, what is the maximum number of homes in the entire tract development?
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61. Will your upcoming work involve new construction on townhouses?
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Yes
No
62. Will your upcoming work involve repair or remodel work on townhouses?
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Yes
No
63. Will you do work for a stalled, abandoned, or otherwise interrupted construction project?
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Yes
No
64. Have you ever worked on the conversion of apartments to condominiums?
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Yes
No
65. Do you perform roof tear off operations?
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Yes
No
66. Do you subcontract roof tear off operations to others?
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Yes
No
67. Do you perform any heat application roofing operations, including but not limited to hot tar, torch down, hot air welding, or use any equipment that has an open flame or produces heat or sparks?
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Yes
No
68. Do you perform any work utilizing the spraying of flammable liquids?
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Yes
No
69. Are your employees NRCA Torch Application Certified?
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Yes
No
70. How many years of experience do you have with heat application roofing methods?
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71. Do you use subcontractors?
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Yes
No
If yes, what percentage of your work is subcontracted?
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72. Do you utilize a standard subcontractor indemnification agreement?
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Yes
No
73. Do you obtain a standard written agreement from all subcontractors on all jobs?
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Yes
No
74. Do you collect certificates of insurance showing additional insured coverage for you from all subcontractors?
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Yes
No
75. Do you allow subcontractors to begin work prior to the collection of certificates of insurance?
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Yes
No
76. Do you have a procedure for reviewing and maintaining certificates of insurance?
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Yes
No
77. List your five largest projects completed in the past five years: (project name/description)
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78. List your five largest projects completed in the last 12 months:
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79. Do you use cranes?
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Yes
No
80. Do you use scaffolding?
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Yes
No
81. What is the maximum height at which you work?
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Single Story
2 Stories
3 Stories
4 Stories
5 Stories
6 Stories
7 Stories
82. Have there been any claims or suits against you in the past five years?
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Yes
No
83. Are there any claims or legal actions pending against any entity named in this application?
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Yes
No
84. After inquiry, do you have knowledge of any pre-existing act, omission, event, condition or damage to any person or property that might reasonably be expected to give rise to any future claim or legal action against any person or entity identified in this application?
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Yes
No
85. Have you been accused of any faulty construction in the past five years?
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Yes
No
86. Have you been accused of breach of contract in the past five years?
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Yes
No
87. How many employees do you have?
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88. Please list all owners names and their percentages of ownership:
89. Prior Work Experience In Construction: Where have you worked? What position did you hold? How long did you hold this position? List anything else that would show that you have experience in the construction field.
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Website.
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FEIN Number.
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Mailing Address.
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Physical Address.
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% of work over 2 stories.
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Payroll figures for the last 4 years.
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Sub costs & receipts for the last 4 years.
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