Exploring the nuances of the Pa01 424 form reveals a comprehensive approach by Penn-America Group, Inc. to assess the specific risks associated with welding operations. This supplemental application is designed to delve deeper into the particulars of a welding business, seeking information directly from applicants regarding their company's operations, including years in business, payroll, sales, and the critical aspect of subcontracted work. By inquiring about the use of subcontractors, including the costs involved and whether certificates of insurance are secured, the form aims to gauge the risk management practices of the applicant. Additionally, the request for information on the liability limits of subcontractors and a three-year loss history with prior carriers provides a clear picture of past risk exposure. The form also requires applicants to list and describe their last three jobs, offering insight into the nature and scale of the projects undertaken. Moreover, an extensive list asks about the specific industries served, which can range broadly from residential to highly specialized sectors like aerospace or chemical, requiring applicants to detail the work performed for these industries. This deeply tailored approach ensures that the insurance provider can accurately assess the risk profile of the welding business, facilitating a more informed underwriting process. The form is not just a procedural necessity, but a critical tool in fostering a comprehensive understanding between welders and insurers, ensuring that coverage aligns closely with the unique risks inherent in the welding industry.
| Question | Answer |
|---|---|
| Form Name | Form Pa01 424 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | welding supp (penn) penn america welding supplemental form |
Welders Supplemental Application
Applicant Name_____________________________________________________________________
Applicant Address___________________________________________________________________
City______________________________ |
State ____________ Zip Code_____________________ |
Number of years in business? _________ |
Payroll______________ Sales _____________________ |
Is any work subcontracted? ______________________ What is the cost? ______________________
Are certificates of insurance secured from subcontractors? ___________________________________
What limits of liability are carried by subcontractors? ________________________________________
Prior carrier and three- year loss history
CarrierYear Premium Describe Losses
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
List and describe the last three jobs performed by the insured including the receipts:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Please provide a description of the typical work performed by the insured including customers served
and end use of any products
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Does the insured perform work for any of the following industries?
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Aerospace |
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Industrial |
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Refineries |
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Aircraft |
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Ladders |
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Residential |
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Automotive |
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Medical |
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Scaffolding |
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Bridges |
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Marine |
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Structural Work |
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Chemical |
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Mining |
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Tanks |
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Commercial |
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Oil/Gas |
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Townhomes |
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Condos |
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Pipelines |
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Tract Homes |
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Cranes, Conveyors |
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Pressurized Vessels |
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Trailer Hitches |
or Hydraulics |
If the answer is yes to any of the above, describe work performed. If there is structural welding, advise the number of stories and type of structural work being performed.
____________________________________________________________________________________
____________________________________________________________________________________
The undersigned is an authorized representative of the applicant and certifies that reasonable inquiry has been made to obtain the answers to questions on this application. He/she certifies that the answers are true, correct and complete to the best of his/her knowledge.
__________________________ __________ |
___________________________ |
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Applicant Signature |
Date |
Producer’s Signature |
Date |
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