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About Your Business

Contractor's License Number

Federal Tax ID Number

Commercial % vs Residential %

Interior % vs Exterior %

Maximum Height Exposure

Maximum Depth Exposure

Class Code Information

Class Code

Employee(s) Duty


# of Employees

FT or PT

Brief Description of Operations:

Any claims in the last 3 years?

If so, how many?

Which policy years?

Amount paid out each year:

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