EXTERMINATOR / PEST CONTROL
INSURANCE PROGRAM
McGRATH INSURANCE GROUP

4170 William Penn Highway  Murrysville, PA.  15668-1890
(724) 327-8474    Fax: (724) 327-7911
Toll Free: 1-800-977-2999    Fax: 1-888-800-0034

www.McGrathInsuranceGroup.com      McGrathInsurance@verizon.net


Company Name:
       License #: 
Contact Person:
       E-Mail: Address: 
Mailing Address:
City:
      State:      Zipcode: 
Phone Number:
      Fax: 
General Underwriting
1. Desired Policy Effective Date
2. Limit of Liability Desired:  $ 300,000/Occurrence  $ 500,000/Occurrence  $ 1,000,000/Occurrence
3. General Liability Deductible:  ($ 1,000 minimum deductible): 
4. Prior Insurance Carrier:          Last Year's Sales:$ 
5. How Long have you been in business?  Years
Have there been any changes in ownership, name or business operations in the last three (3) years?   If yes explain....
Yes
No
6. Is the owner active in the business?
Yes
No
7. List Your three largest clients:


8. Breakdown of your clients.............
Commercial
%
Residential
%
9. Are you a member of the Pest Control Association?
Yes
No
10. Do you engage in any business other than Pest Control?
      If Yes, please describe:
Yes
No
11. Do you engage in any drilling operations as regards to pesticide applications?
Yes
No
12. Are warnings posted prior to work performed?
Yes
No
13. How long do you maintain records on work performed?
Yes
No
14. Describe procedures used to ensure sub-contractors are adequately insured and supply proof of insurance
15. Do you provide WDO / WDI inspections?
       a) Average amount of time spent performing a pest inspection.......:  HH:MM
       b) Number of inspections done annually for real estate closings.....: 
Yes
No
16. Have you ever performed treatments or inspections to homes constructed with any type of exterior insulation finishing systems or synthetic stucco system?
      If Yes, approximately how many homes: 
Yes
No
17. If Termite baiting systems are used, please complete the following:
      a. Brand of baiting system.........: 
      b. Are customers told or given written guidelines explaining the time frame between bait transfer an colony elimination?
      c. Are technicians trained by a system manufacturer as to the use of the baiting system?
          If No, what type of training do technicians receive: 
      d. If there a written log to confirm that the technician acted in accordance with the manufacturer specifications on all accounts?
Yes
Yes

Yes

No
No

No

18. List chemicals normally used: 
19. Do you mix chemicals of others and place their labels on them?
Yes
No
20. Do you engage in retail sales of chemicals?
Yes
No
21. Are chemicals stored and handled as received from the manufacturer?
      If NO, what alterations are made prior to sale? 
Yes
No
22. How Are Chemicals Stored?  Above ground tanks  Underground Tanks  If Other, please describe: 
23. Are premises controlled regarding access to chemical storage areas?
Yes
No
24. Are chemicals stored in manufacture's containers in a separate building?
      If Yes, describe building: 
Yes
No
25. Describe precautions used to secure chemicals at your business...: 
      What is the maximum volume of chemicals stored at your location: 
26. Describe precautions used to secure chemicals at customer's locations....: 
      What is the maximum volume of chemicals stored at customer's locations: 
27. What is the radius of transportation of chemicals: 
28. How many vehicles are used to transport chemicals? 
29. What is the maximum volume stored in any one vehicle? 
30. Describe the method of securing chemical containers while in transit? 
31. Do you have a standard operating procedure for containment of chemicals in the event of an auto collision or overturn vehicle?
      If Yes, please explain: 
Yes
No
PERSONNEL & TRAINING
32. Home many employees (excluding owners) are employed?
      Clerical:             Technicians:             Sales: 
33. What training is provided for non-certified employees? 
34. Does training programs include a minimum of four (4) weeks of on-the-job training with a supervisor?
Yes
No
35. Are new employees supervised until training is complete?
Yes
No
SALES & PAYROLL
36. What are your gross annual sales: $ 
SERVICES Estimated Gross Sales/Receipts Estimate Gross Payroll Chemicals/Products or Baiting Systems Utilized
Service as WDO / WDI Inspector only
Extermination: Insects other than Termites & Mosquitos
Extermination: Termites
Extermination: Mosquitoes
Extermination: Rodents
Landscape gardening, pruning, repairing, etc
Tree/Shrub or lawn spraying, dusting, etc
Fumigation
Radon Testing
Other Operations
     Specify: 
Sub-Contractors (outside contractors)
Cost



M c G R A T H   I N S U R A N C E   G R O U P

4170 William Penn Highway     Murrysville, PA. 15668-1890
(724) 327-8474              (FAX) 327-7911
Toll Free: 1-800-977-2999       (FAX) 1-888-800-0034