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ACORD 186 (2009/03) 1 of 10
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Universal wording updates to improve clarity and intent were made to all FIG text for this form on 06/30/2009. |
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Section Name |
Field Name |
Field and/or Section Description |
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TITLE ACORD 186 (2009/03) |
Contractors Supplement |
The title of the form. ACORD 186, Contractors Supplement, is used as a supplement to ACORD 126, Commercial General Liability Section, or ACORD 160, Business Owners Policy Application when applying for commercial insurance for the following contractor classes: * Air Conditioning and Heating * Cabinetmakers * Carpentry * Electrical Wiring * Excavation and Grading of Land or Septic Installation * Insulation * Landscaping * Masonry * Painting * Plumbing * Roofing |
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IDENTIFICATION |
Agency Customer ID |
Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage). |
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IDENTIFICATION |
Date |
Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY) |
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IDENTIFICATION |
Agency |
Enter text: The full name of the producer/agency. |
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IDENTIFICATION |
Named Insured(s) |
Enter text: The named insured(s) as it/they will appear on the policy declarations page. |
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IDENTIFICATION |
Policy Number |
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. |
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IDENTIFICATION |
Effective Date |
Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. |
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IDENTIFICATION |
Carrier |
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. |
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IDENTIFICATION |
NAIC Code |
Enter code: The identification code assigned to the insurer by the NAIC. |
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IDENTIFICATION |
Type of Contractor |
Enter text: The contractor class as described in ACORD 126 or ACORD 160. |
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IDENTIFICATION |
Years Experience |
Enter number: The contractor's number of years of experience. |
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IDENTIFICATION |
Full Time |
Enter number: The number of full time employees. |
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IDENTIFICATION |
Part Time |
Enter number: The number of part time employees. |
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IDENTIFICATION |
Contractor's License Number |
Enter identifier: The state or local license number for the applicant. |
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IDENTIFICATION |
Owner |
Check the box (if applicable): Indicates the license holder is the owner of the business. |
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IDENTIFICATION |
Officer |
Check the box (if applicable): Indicates the license holder is an officer of the business. |
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IDENTIFICATION |
Employee |
Check the box (if applicable): Indicates the license holder is an employee of the business. |
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IDENTIFICATION |
Other |
Check the box (if applicable): Indicates the license holder has a relationship with the business other than those listed. |
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IDENTIFICATION |
Describe Other |
Enter text: The relationship the license holder has with the business. |
ACORD 186 (2009/03) 2 of 10
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Section Name |
Field Name |
Field and/or Section Description |
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IDENTIFICATION |
% Residential |
Enter percentage: The percentage of work that is residential. |
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IDENTIFICATION |
% Commercial |
Enter percentage: The percentage of work that is commercial. |
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IDENTIFICATION |
% New Construction |
Enter percentage: The percentage of work that is new construction. |
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IDENTIFICATION |
% Remodel |
Enter percentage: The percentage of work that is remodeling. |
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IDENTIFICATION |
Gross Receipts |
Enter amount: The total annual gross sales or receipts. |
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IDENTIFICATION |
Payroll |
Enter amount: The total annual payroll of the business in whole dollars. |
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IDENTIFICATION |
Minimum GL Limits Occurrence |
Enter limit: The general liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is the minimum limit. |
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IDENTIFICATION |
Minimum GL Limits Aggregate |
Enter limit: The general liability, general aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is the minimum limit. |
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IDENTIFICATION |
Total Cost of Subcontracted Work Past Year |
Enter amount: The total cost of subcontracted work for the past 12 months. |
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IDENTIFICATION |
Explosive Environments |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Explosive Environments (Paints, Solvents, etc.)? |
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IDENTIFICATION |
Installation of Emergency Back-up Equipment. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Installation of Emergency Back-up Equipment?". |
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IDENTIFICATION |
Airport Construction or Repair. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Airport Construction or Repair?". |
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IDENTIFICATION |
Dam, Bridge, or River Related Construction. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Dam, Bridge or River Related Construction?". |
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IDENTIFICATION |
Petrochemical Plants. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Petrochemical Plants?". |
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IDENTIFICATION |
Fire Alarm or Automatic Sprinkler Design, Install or Repair. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Fire Alarm or Automatic Sprinkler Design, Install Repair?". |
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IDENTIFICATION |
Burglar Alarm Design, Install or Repair. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Burglar Alarm Design, Install or Repair?". |
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IDENTIFICATION |
High Voltage (over 480 volts) Or High Amperage. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around High Voltage (over 480 volts) or High Amperage? |
ACORD 186 (2009/03) 3 of 10
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Section Name |
Field Name |
Field and/or Section Description |
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IDENTIFICATION |
Major Electrical Control Panels. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Major Electrical Control Panels?". |
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IDENTIFICATION |
Nuclear Plants. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Nuclear Power Plants?". |
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IDENTIFICATION |
Hospitals. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Hospitals?". |
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IDENTIFICATION |
Power Plants. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Power Plants?". |
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IDENTIFICATION |
Traffic Signal Works. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Traffic Signals?". |
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IDENTIFICATION |
Oil or Gas Refiners. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Oil or Gas Refineries?". |
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IDENTIFICATION |
Power Lines. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Power Lines?". |
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GENERAL INFORMATION |
Swimming Pools. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Swimming Pools?". |
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GENERAL INFORMATION |
Hot or Live Wires. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Hot or Live Wires?". |
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GENERAL INFORMATION |
Land Fill. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Land Fills?". |
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GENERAL INFORMATION |
Hazardous Material Abatement. |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any work done in or around Hazardous Material Abatement?". |
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GENERAL INFORMATION |
Other Exposure Description |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any other types of exposures?". |
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GENERAL INFORMATION |
Other Exposure. |
Enter text: The description of the exposure. |
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GENERAL INFORMATION |
Does applicant draw plans, designs, or specification for others? |
Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Does applicant draw plans, designs or specifications for others?". |
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GENERAL INFORMATION |
Do any operations include blasting or utilize or store explosive material? |
Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Do any operations include blasting or utilize, or store explosive material?". |
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GENERAL INFORMATION |
Do any operations include excavation, tunneling, underground work or earth moving? |
Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Does any operation involve excavation, tunneling, underground work or earth moving?". |
ACORD 186 (2009/03) 4 of 10
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Section Name |
Field Name |
Field and/or Section Description |
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Is there a formal, written safety |
Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Is |
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GENERAL INFORMATION |
and security policy in effect? |
there a formal, written safety and security policy in effect?". |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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GENERAL INFORMATION |
Any demolition or wrecking work? |
question, "Any demolition or wrecking work?". |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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GENERAL INFORMATION |
Any use of cranes? |
question, "Any use of cranes?". |
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Do your subcontractors carry |
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coverages or limits less than |
Enter Y for a “Yes” response. Input N for “No” response. The response to the question, |
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GENERAL INFORMATION |
yours? |
"Do subcontractors carry coverages or limits less than applicant?". |
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Are subcontractors allowed to |
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work without providing you with a |
Enter Y for a “Yes” response. Input N for “No” response. The response to the question, |
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GENERAL INFORMATION |
certificate of insurance? |
"Are subcontractors allowed to work without providing you with a certificate of insurance?". |
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Does applicant lease equipment to |
Enter Y for a “Yes” response. Input N for “No” response. The response to the question, |
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GENERAL INFORMATION |
others with or without operators? |
"Does applicant lease equipment to others with or without operators?". |
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Any boats, docks, floats owned or |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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GENERAL INFORMATION |
leased? |
question, "Any boats, docks, floats owned or leased?". |
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SPECIFIC CONTRACTOR |
Any advertising signs away from |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
premises? |
question, "Any advertising signs away from premises?". |
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Does an employee of the applicant |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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SPECIFIC CONTRACTOR |
have direct oversight of each |
question, "Does an employee of the applicant have direct oversight of each jobsite in |
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INFORMATION |
jobsite in progress? |
progress?". |
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SPECIFIC CONTRACTOR |
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Enter number: The radius of operations for an employee having direct oversight of job |
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INFORMATION |
Radius of operations |
sites in progress. |
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SPECIFIC CONTRACTOR |
Do you lease employees to or from |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
other employees? |
question, "Do you lease employees to or from other employees?". |
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Any operation or owned, leased or |
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SPECIFIC CONTRACTOR |
rented property not covered by |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
this policy? |
question, "Any operation or owned, leased or rented property not covered by this policy?". |
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SPECIFIC CONTRACTOR |
Any product manufactured or sold |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
under the applicant's name? |
question, "Any product manufactured or sold under the applicant's name?". |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any boiler work done? |
question, "Any boiler work done?". |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any asbestos removal done? |
question, "Any asbestos removal done?". |
ACORD 186 (2009/03) 5 of 10
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Section Name |
Field Name |
Field and/or Section Description |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Is dust collection system present? |
question, "Is dust collection system present?". |
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SPECIFIC CONTRACTOR |
Does spray booth meet NFPA |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
standards? |
question, "Does spray booth meet NFPA standards?". |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any roofing done? |
question, "Any roofing done?". |
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SPECIFIC CONTRACTOR |
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INFORMATION |
What percentage? |
Enter percentage: The percentage of work that is roofing work. |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any shop work done? |
question, "Any shop work done?". |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any renovation work done? |
question, "Any renovation work done?". |
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SPECIFIC CONTRACTOR |
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INFORMATION |
What percentage? |
Enter percentage: The percentage of work that is renovation work. |
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SPECIFIC CONTRACTOR |
Any gutting of interior load |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
bearing walls? |
question, "Any gutting of interior load bearing walls?". |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any underground cable work? |
question, "Any underground cable work?". |
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Maximum Depth of excavation & |
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SPECIFIC CONTRACTOR |
grading of land & septic |
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|
INFORMATION |
installation |
Enter number: The maximum depth of excavation & grading of land & septic installation |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Water Lines |
question, "Is there any excavation of water lines?". |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Sewer |
question, "Is there any excavation of sewers?". |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Septic |
question, "Is there any excavation or installation of septic systems?". |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Basements |
question, "Is there any excavation of basements?". |
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SPECIFIC CONTRACTOR |
Other Type of Excavation |
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INFORMATION |
Description |
Enter text: The description of the type of excavation work being done. |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Other Type of Excavation. |
question, "Other Type of Excavation?". |
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SPECIFIC CONTRACTOR |
Any work done in streets or |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
roads? |
question, "Any work done in streets or roads?". |
ACORD 186 (2009/03) 6 of 10
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Section Name |
Field Name |
Field and/or Section Description |
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SPECIFIC CONTRACTOR |
Are excavations marked and |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
guarded at end of day? |
question, "Are excavations marked and guarded at end of day?". |
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SPECIFIC CONTRACTOR |
Are utilities staked before the start |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
of every dig? |
question, "Are utilities staked before the start of every dig?". |
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SPECIFIC CONTRACTOR INFORMATION |
If telephone inquiries are made, is a log maintained showing date, time, person spoken to, plot # and map # referred to? |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "If telephone inquiries are made, is a log maintained showing date, time, person spoken to, plot # and map # referred to?". |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any snowplowing? |
question, "Any snowplowing done?". |
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SPECIFIC CONTRACTOR |
Is shoring work done in |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
accordance with standards? |
question, "Is shoring work done in accordance with standards?". |
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SPECIFIC CONTRACTOR |
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Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any removal? (Insulation) |
question, "Any insulation removal?". |
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SPECIFIC CONTRACTOR |
Any encapsulation or removal of |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
asbestos? |
question, "Any encapsulation or removal of asbestos?". |
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Has applicant applied or installed |
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any exterior insulation or |
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finishing, or any exterior |
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insulation finishing systems (EIFS) |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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SPECIFIC CONTRACTOR |
related product or materials in the |
question, "Has applicant applied or installed any exterior insulation or finishing, or any |
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INFORMATION |
past? |
exterior insulation finishing systems (EIFS) related product or materials in the past?". |
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Have you been involved with the |
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application or installation of |
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material that is directly in contact |
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with EIFS, such as windows, |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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SPECIFIC CONTRACTOR |
doors, paint caulk or flashing |
question, "Have you been involved with the application or installation of material that is |
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INFORMATION |
materials? |
directly in contact with EIFS, such as windows, doors, paint caulk or flashing materials?". |
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If you are a general contractor or |
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subcontractor using |
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subcontractors, have you managed projects or operations |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "If you are a general contractor or subcontractor using subcontractors, have you |
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SPECIFIC CONTRACTOR |
using EIFS or EIFS related |
managed projects or operations using EIFS or EIFS related products as the exterior |
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INFORMATION |
products as the exterior finish? |
finish?". |
ACORD 186 (2009/03) 7 of 10
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Section Name |
Field Name |
Field and/or Section Description |
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SPECIFIC CONTRACTOR |
Have you had any EIFS related |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
losses? |
question, "Have you had any EIFS related losses?". |
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SPECIFIC CONTRACTOR |
Any grading of land or excavation |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
|
INFORMATION |
work done? |
question, "Any grading of land or excavation work done?". |
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SPECIFIC CONTRACTOR |
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INFORMATION |
What percentage? |
Enter percentage: The percentage of work done that is grading of land or excavation. |
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Any spraying of bushes, lawns, etc |
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SPECIFIC CONTRACTOR |
with pesticides, herbicides, or |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
fertilizers? |
question, "Any spraying of bushes, lawns, etc with pesticides, herbicides, or fertilizers?". |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any tree trimming work done? |
question, "Any tree trimming work done?". |
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SPECIFIC CONTRACTOR |
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INFORMATION |
What percentage? |
Enter percentage: The percentage of work done that is tree trimming. |
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SPECIFIC CONTRACTOR |
Any work done during "off |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
season" months? |
question, "Any work done during "off season" months?". |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any snowplowing done? |
question, "Any snowplowing done?". |
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SPECIFIC CONTRACTOR |
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|
INFORMATION |
What percentage? |
Enter percentage: The percentage of work done that is snow plowing. |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Do you excavate also? |
question, "Do you excavate also?". |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any retaining walls built? |
question, "Any retaining walls built?". |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any mix-in-transit? |
question, "Any mix-in-transit?". |
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SPECIFIC CONTRACTOR |
Any work involving load-bearing |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
walls? |
question, "Any work involving load-bearing walls?". |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION |
Any basement work? |
question, "Any basement work?". |
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Enter identifier: The customer's identification number assigned by the producer (e.g. |
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IDENTIFICATION |
Agency Customer ID |
agency or brokerage). |
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SPECIFIC CONTRACTOR |
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INFORMATION (continued) |
Painting Inside Percentage |
Enter percentage: The percentage of painting work that is inside. |
ACORD 186 (2009/03) 8 of 10
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Section Name |
Field Name |
Field and/or Section Description |
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SPECIFIC CONTRACTOR |
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INFORMATION (continued) |
Painting Outside Percentage |
Enter percentage: The percentage of painting work that is outside. |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION (continued) |
Any work done above 2 stories? |
question, "Any work done above 2 stories?". |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION (continued) |
Any scaffolding used? |
question, "Any scaffolding used?". |
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SPECIFIC CONTRACTOR |
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|
INFORMATION (continued) |
To what height? |
Enter number: The height of scaffolding used. |
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SPECIFIC CONTRACTOR |
Any painting of tanks, water or |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION (continued) |
gas? |
question, "Any painting of tanks, water or gas?". |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION (continued) |
Any painting of bridges or towers? |
question, "Any painting of bridges or towers?". |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION (continued) |
Any exterior spray painting? |
question, "Any exterior spray painting?". |
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SPECIFIC CONTRACTOR |
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INFORMATION (continued) |
What percentage? |
Enter percentage: The percentage of painting work that is exterior spray painting. |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION (continued) |
Any airless spray guns used? |
question, "Any airless spray guns used?". |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION (continued) |
Any epoxies used? |
question, "Any epoxies used?". |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION (continued) |
Any lead paint removal done? |
question, "Any lead paint removal done?". |
ACORD 186 (2009/03) 9 of 10
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Section Name |
Field Name |
Field and/or Section Description |
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Any installation of high pressure |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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SPECIFIC CONTRACTOR |
systems, caustics, flammables, |
question, "Any installation of high pressure systems, caustics, flammables, gases or |
|
INFORMATION (continued) |
gases or chemicals? |
chemicals?". |
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SPECIFIC CONTRACTOR |
Any refrigeration systems |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
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INFORMATION (continued) |
installed? |
question, "Any refrigeration systems installed?". |
|
SPECIFIC CONTRACTOR |
Any mechanical contracting |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
|
INFORMATION (continued) |
operations? |
question, "Any mechanical contracting operations?". |
|
Are proper written procedures in |
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SPECIFIC CONTRACTOR |
place with respect to "sweating" of |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
|
INFORMATION (continued) |
pipes? |
question, "Are proper written procedures in place with respect to "sweating" of pipes?". |
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SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
|
INFORMATION (continued) |
Any septic tank installation? |
question, "Any septic tank installation?". |
|
SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
|
INFORMATION (continued) |
Any asbestos removal done? |
question, "Any asbestos removal done?". |
|
SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
|
INFORMATION (continued) |
Any work above two stories? |
question, "Any work above two stories?". |
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SPECIFIC CONTRACTOR |
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|
INFORMATION (continued) |
Commercial % |
Enter percentage: The percentage of roofing work that is done commercial buildings. |
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SPECIFIC CONTRACTOR |
|
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INFORMATION (continued) |
Residential % |
Enter percentage: The percentage of roofing work that is done on residential buildings. |
|
SPECIFIC CONTRACTOR |
|
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
|
INFORMATION (continued) |
Is hot tar used? |
question, "Is hot tar used?". |
|
Section Name |
Field Name |
Field and/or Section Description |
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SPECIFIC CONTRACTOR INFORMATION (continued) |
Are written procedures in place to assure that an opening in the roof will never left unattended and will be properly covered an anchored before leaving the jobsite? |
Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are written procedures in place to assure that an opening in the roof will never left unattended and will be properly covered an anchored before leaving the jobsite?". |
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Enter text: The contractors underwriting general remarks. Enter any additional information |
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SPECIFIC CONTRACTOR |
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required for underwriting or rating. Attach ACORD 101, Additional Remarks Schedule, if |
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INFORMATION (continued) |
Remarks |
more space is required. |
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The edition identifier of the form including the form number and edition (the date is |
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Edition |
Date |
typically formatted YYYY/MM). |
ACORD 186 (2009/03) 10 of 10
|