Disclaimer: The Construction Risk Identification Program (CRIP) remains the sole intellectual property of Business Insurance Associates, Inc. Reproduction of this document without the expressed written consent of Business Insurance Associates, Inc. is expressly prohibited. This program is designed to gather information for the purposes of identifying various exposures and liabilities a contractor may face. This document does not constitute a guarantee to provide any specific coverages and does not represent a legal agreement. It is a tool to assist the contractor and our producers in identifying potential risks. The ownership and employees of Business Insurance Associates, Inc. assume no liability with regards to the decisions a contractor decides to make with regards to their risk identification and management programs.

Respond to all of the questions below with accuracy and completeness. The answers you provide will be retained by BIA, Inc. in hardcopy at our office, available for your review upon written request. As with other transactions, the Business Insurance Associates, Inc. privacy and confidentialty policy is fully recognized with respects to this program, and all other business activity conducted.

Contact Information

Business Name
Main Contact Name
Phone Number
Fax Number
Email Address
Website


Business Information

Date Established
Date Incorporated

Entity Type (select one)

Sole Proprietorship Partnership S Corporation C Corporation LLC

Area of Operations (check all that apply)

Matsu Valley (Palmer, Wasilla, Houston, Sutton)
Kenai Peninsula (Kenai, Soldotna, Homer, Nikiski)
Interior (Fairbanks, Delta Junction, Healy)
Southeast Alaska (Juneau, Sitka, Wrangell, Haines)
Southwest Alaska (Kodiak, Iliamna, Aleutians)
Southcentral (Seward, Valdez, Cordova, Whittier)
Greater Anchorage (Anchorage, Eagle River, Chugach)
Western Alaska (Dillingham, Nome, Kotzebue)
Arctic North Slope
Pacific Northwest (Alaska, Oregon, Washington)
Lower 48 (states other then pacific northwest)

Revenue & Payroll

2008
2007
2006


Business Planning

Do you have a written business plan in place...?
Yes No

Do you have a written business continuity plan in place...?
Yes No

Is the business continuity plan backed with a buy-sell agreement...?
Yes No

Is the business continuity plan backed by life insurance policies...?
Yes No

Have you acquired any outside operations in the last five years...?
Yes No

Do you plan to acquire any outside operations in the future...?
Yes No


Operational Planning

Do you intend to change the project scope of your operations in the future...?
Yes No

Do you intend to change the geographic area of operations in the future...?
Yes No

Do you intend to change average project size or backlog in the future...?
Yes No

Do you intend to acquire any real estate, equipment or other capital expenditures...?
Yes No

Do you conduct any operations underground...?
Yes No

Do you conduct any operations on or near navigable water...?
Yes No

Do you perform any blasting operations...?
Yes No

Do you manufacture or fabricate any equipment, components or parts...?
Yes No

Please explain any "yes" answers in more detail.




Ownership

Name of Owner and %
Name of Owner and %

Do owners have written wills in place...?
Yes No

Do owners have life insurance policies...?
Yes No


Operations

Type of work performed (check all that apply)

Commercial Builder & Remodel
Residential Builder & Remodel
Industrial Builder & Remodel
Highway & Road Construction
Excavation, Water & Sewer
Concrete & Asphalt
Electrical & Telecommunications
HVAC & Mechanical
Flooring
Drywall
Painting & Coating
Carpentry, Rough & Finish
Marine & Dredging
Roofing
Masonry & Tile
Electronic & Alarms
Landscape & Fencing
Welding
Sheet Metal

Identify all of the Trades you employ




Subcontractors

% Annual Volume Subcontracted
Trades Subcontracted

Do you require subcontractors provide certificates of insurance...?
Yes No

Do you require subcontractors carry limits equal or greater then yours...?
Yes No

Do you require subcontractors sign contracts prior to beginning work...?
Yes No

Do you require subcontractors to name you as additional insured...?
Yes No

Do you require subcontractors to give you a waiver of subrogation...?
Yes No

Do you require subcontractors on the site to be covered on workers comp...?
Yes No

Do you require subcontractors post performance & payment bonds...?
Yes No


Auto, Trucks & Other Equipment

Do employees drive company vehicles...?
Yes No

Do employees drive company vehicles home at night or on the weekends...?
Yes No

Do employees drive personal vehicles for work...?
Yes No

Are employees required to provide evidence of auto insurance...?
Yes No

Do you require employees to carry any specific limits on auto insurance...?
Yes No

Do you pull MVR's on all potential employees that would be driving...?
Yes No

Do you keep updated records on all of your drivers...?
Yes No

Do you have safety meetings and discussions about safe driving and hazzards...?
Yes No

Are any types of drivers ineligible to drive for your company...?
Yes No
If yes, what kind...?

Do you lease vehicles and/or equipment to others...?
Yes No
If yes, do you lease them with operators/drivers...?
Yes No
If yes, do you have written agreements covering the lease...?
Yes No

Do you lease vehicles and/or equipments from others...?
Yes No
If yes, do you lease them with operators/drivers...?
Yes No
If yes, do you have insurance coverage for leased vehicles and/or equipment...?
Yes No
If yes, do you have to sign a written lease agreement...?
Yes No

Number of Owned Vehicles by Type

0 1 2 3 4 5+ Passenger Auto's
0 1 2 3 4 5+ Buses & Vans
0 1 2 3 4 5+ Trucks, Light
0 1 2 3 4 5+ Trucks, Heavy
0 1 2 3 4 5+ Tractors
0 1 2 3 4 5+ Trailers
0 1 2 3 4 5+ Excavators & Dozers
0 1 2 3 4 5+ Booms & Cranes
0 1 2 3 4 5+ Watercraft
0 1 2 3 4 5+ Aircraft


Business Premise Information

Premise Number One

Street Address
City & Zip Code
Purpose of Premise
Building Construction
Total Value of Property
Total Value of Structure(s)
Total Value of Contents
Total Value of Computers

Yes No - Is there a working sprinkler system...?

Yes No - Is there a working alarm system...?

Describe any upgrades to major systems (ie. electrical, roof, plumbing, etc)



Yes No - Is this premise leased or rented...?
If Yes, describe property owner and arrangement.


Premise Number Two

Street Address
City & Zip Code
Purpose of Premise
Building Construction
Total Value of Property
Total Value of Structure(s)
Total Value of Contents
Total Value of Computers

Yes No - Is there a working sprinkler system...?

Yes No - Is there a working alarm system...?

Describe any upgrades to major systems (ie. electrical, roof, plumbing, etc)



Yes No - Is this premise leased or rented...?
If Yes, describe property owner and arrangement.



Commercial & Residential Builders Risk

Do you engage in new residential construction or major system overhauls...?
Yes No

Do you engage in new commercial construction or major system overhauls...?
Yes No

Do you purchase builders risk coverage on any projects...?
Yes No
If yes, does it allow for a waiver of subrogation among all parties...? Yes No
If yes, does it allow for partial occupany and use by owners...? Yes No
If yes, does it cover damage to material on site or in transit...? Yes No
If yes, does it cover damage to adjacent or adjoining properties...? Yes No
If no, who purchased builders risk on projects you are on...? Owner General Contractor

Do you purchase difference in conditions coverage on builders risk others have...?
Yes No


Design Services

Do any of your employees engage in design services (ie. architecture/engineering)...?
Yes No
If yes, do you carry professional liability coverage...? Yes No
If yes, number of architects and engineers on your staff.

Do you subcontract out design services to other firms...?
Yes No
If yes, do you verify design professional carries professional liability...? Yes No

Do you act in the capacity of a subcontractor for design firms...?
Yes No
If yes, does a qualified employee/officer review contractual terms thoroughly...? Yes No


Environmental/Hazardous Materials

Materials that employees have contact with (check all that apply)
Mold
Asbestos
Stucco/Ephis
Contaminated Soil

Materials that subcontractors have contact with (check all that apply)
Mold
Asbestos
Stucco/Ephis
Contaminated Soil

If any of the boxes above (employees or subcontractors) are checked, describe in more detail.




Contracting Policies & Procedures

Are your contracts with owners & upstream contractors standard form (ie. AGC, AIA)...?
Yes No
Describe procedures for negotiating, reviewing, approving and administering contracts.




Safety & Medical Care

Do you have a written safety plan that is periodically reviewed and updated...?
Yes No
Do you offer employees/officers any type of medical plan or health coverage...?
Yes No
Do you have regular safety meetings attended by employees and subcontractors...?
Yes No
Do you have first aid and other medical facilities on project sites...?
Yes No


Employees & Staff

Do you have an employee handbook that every employee is issued...?
Yes No
Do you have a policies & procedures manual that is available for employees to reference...?
Yes No

List the average number of employees by each classification
Full-Time Employees
Part-Time Employees
Summer Season
Winter Season

Do you lease employees to other businesses...?
Yes No

Do other businesses lease employees from you...?
Yes No

Describe any key employees (ie. name, position, responsibilities, etc)


Would the loss of any single employee significantly affect operations...?
Yes No

Do you carry any life insurance policies on key employees...?
Yes No

Do you carry fidelity coverage and/or crime coverage that protects against employee theft...?
Yes No

Do you carry Employment Practices Liability Insurance (EPLI)...?
Yes No

Who handles human resource issues in your business...?


Where do you hire your employees from...?


Describe any training or continuing educations employees are given.



Advertising

Indicate which formats you advertise your business in (check all that apply)

Newspaper
Magazines
Television
Radio
Sponsorships
None

Approximately how much annual revenue do you spend on advertising...?


Are advertisements developed in-house or hired out to a advertising design firm...?


Describe any guarantees or promises your advertisements and/or website make.



Current Insurance Coverages

General Liability
Company
Policy Term
Policy Limits

Workers Compensation
Company
Policy Term
Excluded

Commercial Auto
Company
Policy Term
Policy Limits

Property
Company
Policy Term
Policy Limits

Equipment/Inland Marine
Company
Policy Term
Policy Limits

Professional Liability
Company
Policy Term
Policy Limits

Excess Liability/Umbrella
Company
Policy Term
Policy Limits

Describe any surety bonds (ie. contractors license, right of way bond, etc) you have.


Do you perform any work under wrapup programs...?
Yes No


Accounting/Finances

Fiscal Year End

Name of CPA Accountant

Name of Inhouse Accountant

What level of assurance are financial statements completed with...?
CPA Audit
CPA Reviewed
CPA Compiled
In House

On what basis are financial statements based...?
Cash
Completed Job
Accrual
Percentage of Completion

On what basis are taxes paid...?
Cash
Completed Job
Accrual
Percentage of Completion

How often are financial statements prepared...?
Annually
Semi-Annually
Quarterly
Monthly

Describe inhouse accounting controls for check writing & accounting verification.


Describe procedures for collecting accounts receivable.


Describe procedure for injecting emergency cash flow.



Project Management

Do you prequalify projects owners and ensure adequate funding is in place...?
Yes No

Do you have adequate systems in place to review contractual agreements...?
Yes No

Do you have adequate systems in place to establish & monitor construction schedules...?
Yes No

Do you have adequate systems to monitor construction costs and expenses...?
Yes No

Do you have adequate systems in place to handle change orders...?
Yes No

Are billings completed and submitted in a timely fashion...?
Yes No


Materials/Suppliers

Briefly describe type, amount and value of inventory kept on hand.


Briefly describe top 5 material suppliers and what they supply.


Briefly describe any material problems if a supplier went down.


Hitting the submit button below will send all of the information you've completed thus far to Business
Insurance Associates, Inc. Once received, we will begun conducting our internal risk management review,
a process that generally takes a couple of days to complete. During this time we may have additional
questions or require clearification, and may contact you. In addition, we request you submit the documents
requested below via fax, mail or email to our office.

Additional Submission Documents

Copy of Written Business Plan

Copy of Written Business Continuity Plan

Copy of Written Safety Plan

Three Years of Corporate Financial Statements

Copy of Owner(s) Personal Financial Statements

Copy of Owner(s) Credit Report

Copy of Resume for Owner(s) and Key employee(s)

Copy of Standard Subcontractor Agreement

Copy of Lease Agreements (equipment, property, etc)

Copy of Equipment & Vehicle List (values, radius of operations)

Copy of Standard Contract used with Design Firms

Copy of any Marketing Materials & Advertisements