Small Artisan Supplemental: 		

Insured Name: 

Years in business under above name       
                                                            
Total years of experience in this field  

Is this new business venture                Yes               No

Is Applicant Licensed                 Yes                  No

If yes   License Type 

            License Number
	
	License Issuing Year 

Number of losses in last 3 years                       (Attach hard copy loss runs)

Percentage of business                                     % New Construction

				                           % Repair\Renovation

Percentage of business                                     % Interior Work

				                           % Exterior Work

Percentage of business                                     % Commercial 

				                           % Residential

Any work done in the 5 boroughs of NYC              Yes             No

Any Subcontractors used             Yes             No

If yes, total cost of Subcontractors                                                                                                                                                                                      

Total number of Employees:

                  Owner                            Full Time                       Part Time

Annual Gross Receipts     $

Employee Payroll                     $

Owner Payroll                     $

Type of Work 	Percentage of Total Payroll	

		

Accepted Class Codes
92478 Electrical work - with in bldg
92451 Electrical apparatus – installation, service and repair 
98482 Plumbing – commercial (CG2142 – explosion exclusion)
98483 Plumbing – residential (CG2142 – explosion exclusion)
92338 Drywall
98305 Painting - interior only
98967 Siding
98449 Plastering/stucco work
99746 Tile, stone, marble work
94569 Floor covering installation 
97047 Landscape gardening (CG2134 – Exclude snow plowing)
99777 Tree pruning/landscaping (CG2134 – Exclude snow plowing)
91405 Carpet/upholstery cleaning
95124 Furniture/fixture installation
99650 Television or radio receiving set installation or repair
97650 Metal erection
98884 Sheet metal
92215 Driveway, parking area, sidewalk paving or repaving
99975 Window cleaning – interior only
98344 Paper hanging
99003 Sign painting – Exterior
99004 Sign painting – Interior
96611 Interior Decorators
98678 Roofing

Last three(3) jobs:
Location	Description	Cost	

			
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