• Radon Mitigation Questionnaire

  • Applicant is:
  • How did you hear about us?
  • 4. Do you work directly with a licensed electrician regarding mitigation system installation?
  • 5. Do you provide clients with a written agreement outlining the terms of service for the radon mitigation process? If yes, provide a copy.
  • 6. Does your written agreement/contract include a disclaimer and limitation of liability clause?
  • 8. Are all gas, water, and electrical lines mapped out before installation work begins to prevent accidental rupture?
  • 9. Are post mitigation tests performed to ensure the radon reduction system is working properly?
  • 10. Indicate the percentage of your operations that include:
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  • 10b**. During crawl space encapsulations, do you make any modifications or repairs to the foundation?
  • 12. What is total annual payroll and total annual sales?
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  • 13. How many employees (full-time and part-time)?
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  • 14. Do you subcontract any operations?
  • 14d. Are all subcontractors required to carry commercial general liability insurance?

  • 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://radoncontractorinsurance.com

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