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Municipal Entity Underwriting Application

3.

Percentage of work, such as laying of sewers, removal of sludge, etc., is

Undertaken directly by Entity?

Performed by Independent Contractors?

4.

Is bulk chlorine stored on site?

If yes, how much and describe how stored, protective measures, etc.  

 Yes

 No

Water Utilities

1.

Annual Payroll (excl clerical)?

2.

Gallons per year?

3.

Miles of Pipe?

4.

Type of pipe used?

5.

Is bulk chlorine stored on site?

If yes, how much and describe how stored, protective measures, etc.  

 Yes

 No

6.

Percentage of work, such as laying of waterlines, etc., that is:

Undertaken directly by Entity?

Performed by Independent Contractors?

7.

Source of water supply?

8.

Age of the system?

9.

Date upgraded?

10.

How often is drinking water tested?

11.

By whom?

12.

Does Entity have water supply tanks?

If yes, please list below.

 Yes

 No

Construction

Type

Capacity (gal)

Date Last Inspected

13.

Type of public protection around the tank base(s) (fencing, lighting, aircraft warning lights, runoff channels, etc.)  

14.

Are tanks inspected by qualified engineers?

How often?  

 Yes

 No

15.

Does the system comply with current local and federal standards for hygiene and metals content?

 Yes

 No

Landfills

Location Of Site

Total Acres

Acres In

Use

Acres Fenced

#Yrs In

Control Of Landfill*

8 of 3410/23/2007

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