SNOW REMOVAL QUESTIONNAIRE – RENEWAL

  1. Insured’s Name:Policy Number:
  2. Mailing Address:
  3. Location Address:
  4. What is the annual estimated revenue from all operations?
  5. What is the annual estimated revenue from all snow removal operations?
  6. Are all vehicles used for snow removal licensed for the road?YesNo
  7. How many employees do snow removal?
  8. What kind of areas do you clear? Please provide breakdown of annual revenue for each.

Residential Driveways $ ; Commercial Driveways $ ;

Industrial Driveways $ ;Parking Lots (less than 50 spaces) $ ;

Parking Lots (over 50 spaces) $ ;Highways $ ;

Roads $ ; Walkways $ ;

Other $ (describe)

  1. Do you plough / clear snow: On your own time table ; Only upon customer’s call ; As written in contract ;

If you plough / clear snow on your own timetable, what is the criteria that has been set in place?

  1. Do you apply sand and salt to the ploughed / cleared areas?YesNo
  2. Are snow piles removed?YesNo

If you are responsible to remove snow piles, please provide details of the work performed:

LANDSCAPING SUPPLEMENT – complete only if Insured has Landscaping Operations

  1. What is the annual estimated revenue from all landscaping operations?
  2. What was the actual landscaping revenue in the last 2 years? 20 : $ ; 20: $ ;
  3. Description of landscaping activities:
  1. Spraying/Application (including insecticides, pesticides and herbicides) : Yes No If yes,
  1. Type of Spraying/Application: Extermination Fumigation Lawn Spraying Livestock

Aquatic Greenhouse Other, describe

  1. Location of Spraying/Application: Rural Residential Commercial Industrial Farm Aerial USA
  2. Near any bodies of water? YesNo
  3. Indicate largest sized storage container used for chemicals:
  4. Do you make sure all your employees follow instructions to ensure no abuse of misuse of these products is done and also to avoid any exaggeration with respect to these products? Yes No
  5. Does your firm provide written safety procedures and documents to protect customers? Yes No
  6. Do you or your employees give your clients specific instructions and warning after application of product? Yes No
  1. Do customers check and sign off (approve) work done by you?YesNo
  2. Do you keep a log of job details? (Log should contain: why you went to do the job, when you

arrived and when you finished, what tasks were carried out). Please provide a sample copy of the log.YesNo

  1. Do you have written contracts with customers? Please attach a copy of all contracts. YesNo
  2. Are there hold harmless agreements in place?YesNo

If yes, are they in your favour?YesNo

If not in your favour, please explain:

  1. Are there any verbal contracts with customers?YesNo

If yes, provide full details of work performed under verbal contract(s):

  1. Do you enter into Municipal or Provincial contracts?YesNo

If yes, describe:

  1. Do you subcontract any work to others?YesNo

If yes, do you obtain certificates of insurance from the subcontractors?YesNo

What limit of liability do you require the subcontractors to carry?

Are you added as Additional Insured to the subcontractor’s policy?YesNo

  1. Do you plough / clear any areas used by aircraft or any areas on airport property?YesNo
  2. Have you or any of your snow removal operators taken any specific training courses (i.e. Smart About Salt)?YesNo

WARRANTY STATEMENT

  1. The undersigned, for himself or herself, or as authorized representative of the applicant, declares that to the best of his/her knowledge the statements made and information provided in this application and all questionnaires are true.
  2. Signing this application does not bind the applicant to complete the insurance, but signing here does indicate applicant’s agreement that the application and the information provided will form the basis of the contract should an insurance policy be issued, and this application will become part any issued policy.

April Canada Inc. is hereby authorized to make any investigation and inquiry in connection with this application as necessary. The undersigned, for himself or herself, or as authorized representative understands that April must be advised of any material changes.

  1. It is also agreed that in the event there is any material change in the answers to the questions contained herein prior to the effective date of the insurance policy, the applicant will notify April Canada Inc. and at the sole discretion of April, any outstanding quotations may be modified or withdrawn.

SIGNED BY APPLICANT:

DATE :

(Personally or as authorized representative of the applicant)

NAME:TITLE/POSITION:

(Please Print)(Please Print: President, CEO, CFO, Treasurer)

SUBMITTED BY:DATE :

(Agent/Broker)

#100 1400 1st Street SW
Calgary, AB T2R 0V8
Tel.: 1-855-745-1010
Fax: (403) 237-9976
/ 4405, boulevard Lapinière (Head office) Brossard, QC J4Z 3T5
Tel.: 1-855-745-1010
Fax: (450) 672-5533 / 2550, boulevard Daniel-Johnson,
#420 Laval, Québec H7T 2L1
Tel.: 1-855-745-1010
Fax: 450-681-7313
/ 235 Yorkland Blvd., Suite 1100
Toronto, Ontario M2J 4Y8
Tel.: 1-855-745-1010
Fax: (416) 925-7260
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