Liability Application For Pest Control Program Page 3
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426A.1. Where is insured providing bedbug eradication treatments? (i.e. private homes, apartments, hotels, etc.):
______________________________________________________________________________________________
______________________________________________________________________________________________
26A.2. Method used to eradicate bedbugs? (i.e. chemicals, heat, freezing, etc.) If chemicals, please list chemicals used:
______________________________________________________________________________________________
______________________________________________________________________________________________
26A.3. Experience of technicians and/or owner as respects to bedbug eradication treatments?
______________________________________________________________________________________________
______________________________________________________________________________________________
26A.4. Do you have a specific contract in place for bedbug treatment services?
Yes
No
Does the contract provide any warranties or guarantees as respects to bedbug treatments?
Yes
No
Does the contract indicate multiple treatments may be required?
Yes
No
27.
Do you own or operate any other enterprise?
Yes
No If yes, please provide details of operations and advise
if insured separately: _____________________________________________________________________________
28.
Are any persons performing services under your name as Independent Contractors?
Yes
No If yes, please
describe operation and relationship: _________________________________________________________________
29.
a. General liability insurer and claims history for past three years.
(Even if there are no losses, please provide insurer history.)
Loss
Policy
Policy
Limits of
No. of
Reserve
Company
No.
Dates
Liability
Deductible
Premium
Claims
Amount
b. Name of present Insurance Company: ________________________________ Expires on: ___________________
c. Has insurance ever been cancelled or non-renewed?
Yes
No If yes, explain:
30.
Describe procedures for disposal of empty containers and disposal of unused products:
31.
Describe all spill control procedures:
32.
Do you engage in any drilling operations as regards to pesticide applications?
Yes
No If yes, what
precautions are taken to avoid drilling into service lines (i.e. gas, water, oil, etc.)?
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