Municipal Entity Underwriting Application
Have all recommendations been complied with?
Describe the training of employees in the use of snow removal equipment on roadways.
Is blasting contracted out?
Are Certificates of Insurance and limits at least equal to those carried by your entity required?
NOTE: If 1 or 2 are answered no, please complete the following.
Please describe the types and locations of blasting.
How many blasts per year?
Is the blaster certified?
Please describe the precautions taken prior to blasting.
Who performs utility line installation and repairs?
If contracted, are Certificates of Insurance and limits at least equal to those carried by your entity required?
Annual Payroll (excl clerical)?
Number of customers served?
Does your Entity do any of the following:
Pole Erection / Wire Stringing?
Does the utility generate or purchase power?
If purchased, who is the supplier?
If generated, how (steam, wind, water)?
What is the Maximum Capacity?
Number of miles of high voltage lines?
AMBULANCE SERVICES, RESCUE SQUADS, EMT's OR PARAMEDICS
Is the service municipality owned, private or volunteer?
Please give the number of each of the following certified personnel:
# Of Paid Employees
# Of Volunteers
Emergency Medical Technicians
Radius of operations?
What is the maximum response time?
15 of 3410/23/2007