For any "Yes" answers please explain at the bottom of this section. |
1. Any medical facilities provided or medical professionals employed or contracted? |
Yes
No |
2. Any exposure to radioactive/nuclear materials? |
Yes
No |
3. Do/have past, present or discontinued operations involve(d) storing, treating, discharging, applying, disposing, or transporting of hazardous material (e.g. landfills, wastes, fuel tanks, etc.)? |
Yes
No |
4. Any operations sold, acquired, or discontinued in last five years? |
Yes
No |
5. Machinery or equipment loaned or rented to others? |
Yes
No |
6. Any watercraft, docks, floats owned, hired or leased? |
Yes
No |
7. Any parking facilities owned/rented? |
Yes
No |
8. Is a fee charged for parking? |
Yes
No |
9. Recreation facilities provided? |
Yes
No |
10. Is there a swimming pool on the premises? |
Yes
No |
11. Sporting or social events sponsored? |
Yes
No |
12. Any structural alterations contemplated? |
Yes
No |
13. Any demolition exposure contemplated? |
Yes
No |
14. Has applicant been active or is currently active in joint ventures? |
Yes
No |
15. Do you lease employees to or from other employers? |
Yes
No |
16. Is there a labor interchange with any other business or subsidiaries? |
Yes
No |
17. Are Day Care facilities operated or controlled? |
Yes
No |
18. Have any crimes occurred or been attempted on your premises within the last three years? |
Yes
No |
19. Is there a formal, written safety and security policy in effect? |
Yes
No |
20. Does the businesses' promotional literature make any representations about the safety or security of the premises? |
Yes
No |
If you answered "Yes" to any question above - please explain. |
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