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Municipal Entity Underwriting Application

3.

Have all recommendations been complied with?

 Yes

 No

vi.

Describe the training of employees in the use of snow removal equipment on roadways.  

UTILITIES

1.

Blasting

a.

Is blasting contracted out?

 Yes

 No

b.

Are Certificates of Insurance and limits at least equal to those carried by your entity required?

 Yes

 No

NOTE: If 1 or 2 are answered no, please complete the following.

a.

Please describe the types and locations of blasting.  

b.

How many blasts per year?

c.

Is the blaster certified?

 Yes

 No

d.

Please describe the precautions taken prior to blasting.  

2.

Other

a.

Who performs utility line installation and repairs?

b.

If contracted, are Certificates of Insurance and limits at least equal to those carried by your entity required?

 Yes

 No

Electric Utilities

1.

Annual Payroll (excl clerical)?

2.

Number of customers served?

3.

Does your Entity do any of the following:

 Pole Erection / Wire Stringing?

 Customer Connect?

 Transformer Installation?

 Meter Reading?

4.

Customer Profile:

Residential

Commercial

Industrial

5.

Does the utility generate or purchase power?

If purchased, who is the supplier?  

If generated, how (steam, wind, water)?  

 Yes

 No

6.

What is the Maximum Capacity?

7.

Number of miles of high voltage lines?

AMBULANCE SERVICES, RESCUE SQUADS, EMT's OR PARAMEDICS

1.

Is the service municipality owned, private or volunteer?

 Yes

 No

2.

Please give the number of each of the following certified personnel:

# Of Paid Employees

# Of Volunteers

Certified Personnel

Emergency Medical Technicians

Paramedics

Nurses

3.

Radius of operations?  

4.

What is the maximum response time?

15 of 3410/23/2007

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