Pre-Qualification Questions

Insured Name*

Agency Name*

Agent's Email*

1. Exposure (domiciled or working in) NY, AK, HI or Cook County and/or Dupage County IL except for mono-line WC coverage?*

2. Monoline WC under $7500?*

3. Any work on broadcast towers? 1000+ feet*

4. Subcontracting greater than 75% based on payroll and sub cost or 50% sub cost of total revenue?*

5. Is the business a cell or wi-fi service provider or engineer that does tower design?*

6. New in business with no prior business ownership history?*

7. Does the insured provide staffing operations?*

8. Need coverage bound within 2 weeks that has not previously been discussed & approved by USA Telecom?*