• Biohazard Cleanup Questionnaire

  • Applicant is:
  • How did you hear about us?
  • 3. Does your pre-employment screening process include background checks and drug testing?
  • 4. Are you in compliance with the rules and regulations of: OSHA, the Department of Transportation, the Center for Disease Control and the Environmental Protection Agency?
  • 5. Do you follow the ANSI/IICRC S540 standard for trauma & crime scene cleanup?
  • 7. Are you a member of any trade organizations?
  • 8a. Do your technicians receive regular education and training updates?
  • 9. Is a remediation plan developed for each job?
  • 10. Do you perform any biohazard Level 3 or 4 cleanup services as defined by the Center for Disease Control?
  • 12. Work performed is:
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  • 13. Do you use a written service agreement with your customers? (If yes, please attach a sample copy.)
  • 14. Do you subcontract any operations?
  • 14d. Are all subcontractors required to carry commercial general liability insurance?
  • 16. What is total annual payroll and total annual sales?
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  • 17. How many employees (full-time and part-time)?
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  • OPERATIONS

  • 18. Please indicate what percentage of your operations consist of the following cleanup services:
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  • 21. Do your biohazard cleanup services also include the installation or replacement of damaged property?

  • COMMERCIAL CRIME

  • 1. Do you desire coverage for Crime (Employee Dishonesty, Money, Forgery)?

  • OPTIONAL PROPERTY COVERAGES

  • 1. Do you need Building and/or Content Coverage? (If yes, complete chart below.)
  • 1a. If yes, please provide the information below (or provide information on a separate sheet).
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  • 2. Do you need Computer Coverage?
  • 3. Do you need Outdoor Sign Coverage?
  • 4. Do you need Equipment Coverage?
  • 4a. If yes, total value to insure for?
  • 4b. If yes, please complete equipment schedule below or provide a separate equipment schedule with the following information:
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  • COMMERCIAL AUTOMOBILE INSURANCE

  • 1. Does the business title any automobiles or other operating vehicles in the business name?
  • 2. Is insurance coverage needed for owned automobiles?
  • 2a. (If yes, complete chart below or provide a separate vehicle/fleet schedule with following info.)
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  • 2b. If yes, limits desired:
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  • 3. Do any of the employees, owners or officers drive personally owned automobiles/other vehicles in the course of their work?
  • 3b. Do you verify they have liability coverage?

  • COMMERCIAL UMBRELLA

  • 1. Do you need a Commercial Umbrella?

  • WORKERS' COMPENSATION INSURANCE

  • 1. Do you need Workers Compensation? (If yes, please contact Kevin Morency.)
  • Privacy Policy and Terms & Conditions*

  • SIGNATURE

  • The information I have provided is true and accurate to the best of my knowledge. I have not willfully concealed or misrepresented any material fact(s) or information. I understand completion of this questionnaire does not compel the company to provide coverage.

  • Questions? 877-244-9090
    kmorency@morencyinsurance.com 

    Kevin Morency, Licensed Producer
    Morency & Associates Inc.
    141 New Shackle Island Rd, Hendersonville, TN 37075
    Fax: 615-452-6580

    https://biohazardcleanupinsurance.com

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