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EXCAVATORS QUOTE
Business Name:
Mailing Address:
City  State     Zip
Phone:      Fax: 		PROPOSED EFFECTIVE DATE:
From     To

Email:

Complete this application in addition to the General Liability Quote

1. How long have you been in business?      Full-Time    Part-Time

2.
Employee Data        
 
Number
Annual Payroll
Owner(s) only
$
Full-time
$
Part-time
$
Leased or Subcontracted
Number
Annual Cost
Leased Employees
$
Independent Contractors
$

3. Projected annual sales: $
 

4. Operations:
Yes    No Does applicant or their subcontractors use explosives?
Yes    No Does applicant make a study of the subsurface, including identification of existing utility pipes and lines, prior to any digging?
Yes    No Is all self-propelled mobile equipment transported to job sites by trailer?
Yes    No If shoring is required on a job, does applicant use OSHA approved equipment and techniques?
Yes    No Does applicant have sufficient signs, barricades, and fences to keep non-employees at a safe distance from job sites and equipment?     
Equipment is owned or rented.  
If rented, attach a copy of the certificate of insurance from the rental company.
Yes    No Does applicant do off-season plowing? If yes, annual receipts from snow plowing: $
Yes    No Any underground tanks, petroleum products, LPG, flammable liquids, ammunition or explosives stored on premises? If so, type and quantity stored:
Yes    No Any equipment loaned, leased or rented to others?
If so, describe type of equipment and annual rental receipts:
Yes    No Does applicant subcontract work? If so, state type of work:
Are certificates of insurance obtained from subcontractors? Yes No
Yes    No Any work completed involving underground storage tank removal; tunneling; earthen dam construction; river channeling or rechanneling; mining; work on landfills; street or road construction; or water main, sewer or pipeline construction?
If yes, describe:
Yes    No Site preparation for residential housing?

 

 
 

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