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Collects claims-precondition disclosures, coverage requested and limits, general contractor/subcontracting questions, planned gross receipts, current largest jobs, work-percentage allocation, and past or upcoming specialty work selections.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/guardian-application-usic-cmgia-04-2012-insurance-policy-application-form/278092/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/guardian-application-usic-cmgia-04-2012-insurance-policy-application-form/278092.png","ImageObject",442,249,{"name":42,"@type":43},"Fez","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-23","2026-09-15",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What applicant details are requested in the form?","Question",{"text":63,"@type":64},"The form requests applicant name, contact information, DBA, address, email, phone/fax, producer code, affiliated associations, inspection contact, and physical address if different.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What prior information about losses and carriers is required?",{"text":68,"@type":64},"It asks for prior carrier information for the past three years (coverage effective dates, limits, premiums paid, and number/amount of losses) and specific details on past losses, including a current valued loss run and/or no known loss letter signed and dated by the applicant.",{"name":70,"@type":61,"acceptedAnswer":71},"What questions address contracting structure and upcoming work?",{"text":72,"@type":64},"It asks whether the applicant is a general contractor, whether 100% of work is subcontracted, lists trades with dollar values if not fully subcontracted, and requests gross receipts plus the three largest jobs planned or in progress in the next 12 months.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},278092,1791386022,{"code":4,"msg":82,"data":83},"success",{"doc_id":79,"user_id":84,"nickname":42,"user_avatar":85,"doc_module":22,"category_id":86,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":87,"file_id":88,"file_url":89,"file_type":90,"file_size":91,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":92,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":93,"faqs":94,"seo_title":95,"seo_description":12,"update_tm":96,"read_time":26},2336478940794,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc",17,"UNITED SPECIALTY INSURANCE COMPANY  \nThe words “Applicant”,“You” or “Your” refer to the person or entity applying for the insurance policy.  \nProducer Information: Applicant Information:  \n\n| Name: |  | Name: |  |\n| --- | --- | --- | --- |\n| Contact: |  | DBA: |  |\n| Address: |  | Address |  |\n| E-Mail Address: |  | E-Mail Address: |  |\n| Phone: | Fax: | Phone: | Fax: |\n| Producer Code: |  | FEIN\\#: |  |\n| Affiliated Associations: |  | Inspection Contact: |  |\n\nProvide Your Physical Address if Different from The Address Listed Above:    \nDesired Effective Date of Coverage:   Expiration Date of Current Coverage:  \nEntity Type: 􀂆 Individual 􀂆 Partnership 􀂆 Joint Venture 􀂆 Corporation 􀂆 LLC 􀂆 Other:  \nYears Applicant Has Been in Operation:  (If The Applicant Has Been in Business Less Than 2 Years, Provide Detailed Resumes ofAll Owners, Officers, Members or Partners.) Years of Experience:  List All States which work will be performed in during the policy period:    \nProvide Detailed Description of Your Business, Operations and Services:    \n__________  \nList All Contractor Licenses Held By Applicant in Each State or County or Provide a Current Copy of Each License  \n| License Number | State License is Held |\n| --- | --- |\n|  |  |\n|  |  |\n|  |  |\n\nPrior Carrier Information For The Applicant For The Past 3 Years:  \n\n| Carrier Name | Effective Dates of Coverage | Limits | Premium Paid | Number And Amount of Losses |\n| --- | --- | --- | --- | --- |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n\nPlease Note: A Current Valued Loss Run and/or a No Known Loss Letter, Signed and Dated by The Applicant, is Required.  \nPlease Provide Specific Details on All Past Losses:    \nHave You Owned and/or Operated Any Other Business, Contracting or Otherwise, in the Past 5 Years? 􀂆 Yes 􀂆 No  \nIf Yes, State Your Percentage of Ownership:   Provide a Detailed Description of The Operations:    \nAre You Aware of Any Litigation, Past or Pending Against You The Applicant or Your Business in the Past 5 Years: 􀂆 Yes 􀂆 No  \nIf “Yes”, Explain in Detail:    \nDo You Have Any Knowledge of Any Occurrence, Condition, Act, Omission, Event, Harm or Damages to Any Person or Property that May Potentially Give Rise to Any Future Claim or Legal Action Against The Applicant? 􀂆 Yes 􀂆 No  \nIf “Yes”, Explain in Detail:    \nUSIC-CMGIA 04-2012 Page 1 of 4  \n\n| Coverage Requested: | S.I.R.: | Limits: |  |\n| --- | --- | --- | --- |\n| Manuscript Occurrence – Endorsement(s)\u003Cbr>􀀀 Primary Wording\u003Cbr>􀀀 Waiver of Subrogation\u003Cbr>􀀀 Alien 20 10 11 85\u003Cbr>􀀀 Additional Fire Coverage\u003Cbr>􀀀 Snow Plow (only available to Insured with Commercial Auto Policy)\u003Cbr>􀀀 Blanket Additional Insured-Company Form\u003Cbr>􀀀 Additional Insured\u003Cbr>􀀀 Stop Gap Coverage | 􀂆 $2,500\u003Cbr>􀂆 $5,000\u003Cbr>􀂆 $7,500\u003Cbr>􀂆 $10,000\u003Cbr>􀂆 $  | General Aggregate\u003Cbr>Products-Completed Operations Aggregate\u003Cbr>Personal & Advertising Injury Each Occurrence\u003Cbr>Fire Damage (Any One Fire)\u003Cbr>Medical Expenses (Any One Person) | $ \u003Cbr>$ \u003Cbr>$ \u003Cbr>$ \u003Cbr>$50,000\u003Cbr>$ 5,000 |\n\nA) . Are you a General Contractor? 􀂆 YES 􀂆 NO  \nB) . Do you subcontract out 100% of your work? 􀂆 YES 􀂆 NO  \nC) . If you do not subcontract out all of your work, please list the trades you will perform during the next 12 months and their dollar value:  \n_______________________________________________________________________________________________________________________________________________________  \n_______________________________________________________________________________________________________________________________________________________  \nYour Gross Receipts Next 12 Months: $  Your Actual Gross Receipts Current Year: $   \nYour Actual Gross Receipts Prior Year: $   \nCurrent &/or Planned Work. Please List your 3 Largest Jobs Currently in Progress or with Planned Start Dates in the Next 12 Months:  \n\n| Project Name & Address | Project Type | Work Performed | Anticipated Gross Receipts |\n| --- | --- | --- | --- |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n\nPerc","cbCairsPZsYRwgw8","https://ap.wps.com/l/cbCairsPZsYRwgw8","pdf",313887,"English","# Applicant Information\n# Coverage Requested\n# Operations and Loss History\n# Contractors, Receipts, and Work Details","[{\"question\":\"What applicant details are requested in the form?\",\"answer\":\"The form requests applicant name, contact information, DBA, address, email, phone/fax, producer code, affiliated associations, inspection contact, and physical address if different.\"},{\"question\":\"What prior information about losses and carriers is required?\",\"answer\":\"It asks for prior carrier information for the past three years (coverage effective dates, limits, premiums paid, and number/amount of losses) and specific details on past losses, including a current valued loss run and/or no known loss letter signed and dated by the applicant.\"},{\"question\":\"What questions address contracting structure and upcoming work?\",\"answer\":\"It asks whether the applicant is a general contractor, whether 100% of work is subcontracted, lists trades with dollar values if not fully subcontracted, and requests gross receipts plus the three largest jobs planned or in progress in the next 12 months.\"}]","Guardian Application - USIC-CMGIA 04-2012 - Insurance policy application form | PDF",1789506937,{"code":4,"msg":82,"data":98},[99,104,109,114,119,124,127,132,137],{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},11,"Presentations",90,"presentations",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},12,"Resumes",80,"resumes",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},14,"Invoices",70,"invoices",{"id":115,"doc_module":22,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},15,"Posters",60,"posters",{"id":120,"doc_module":22,"doc_module_name":25,"category_name":121,"show_sort_weight":122,"slug":123},16,"Social Media",50,"social-media",{"id":86,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":125,"slug":126},40,"forms",{"id":128,"doc_module":22,"doc_module_name":25,"category_name":129,"show_sort_weight":130,"slug":131},18,"Letters",30,"letters",{"id":133,"doc_module":22,"doc_module_name":25,"category_name":134,"show_sort_weight":135,"slug":136},21,"Paper Templates",5,"papers-templates",{"id":138,"doc_module":22,"doc_module_name":25,"category_name":139,"show_sort_weight":4,"slug":140},158,"General","general-158"]