EZ Quote Questionnaire
F&E Services
Architects &
Engineers
Get a Quote
Applications
1 - General Information
Firm Name:
Contact Name:
Contact E-mail:
Firm Website:
Principal Location:
Phone:
City:
State:
Zip:
Fax:

2 - Current Status
Is a principal, partner, officer or director a licensed architect, engineer or registered land surveyor?

Is your firm currently insured?

Date Firm Established:

3 - Current Coverage
Current Carrier:
Expiration Date:
Current limits of liability:
Deductible:
Current premium:
Does the current policy provide full Prior Acts Coverage?

If so, what is your Prior Acts date?
Number of years continuously insured?

4 - Service Billing Information
                                                                         Last Fiscal Year / 2nd Last Fiscal Year / Estimated Billings
A. Projects currently covered
      by specific project policy:                    
B. Feasibility studies, reports,
      opinions, landscape, surveying,
      and abandoned projects:                       
C. All other billings:                                       
D. Direct Reimbursables:                            
E. Total gross billings:                                  

5 - Billing Attributes (Are the following greater than 10% of your billings attributes? If yes, please explain in Question 11 below.)
Design/Build

Pollution

Product

Design

Asbestos Services


6 - Seperate Entities
Are you owned by or do you own another entity which provides construction related services?


If yes, please explain in Question 11 below.

7 - Applicant Disciplines (Total must equal 100%)
Acoustical Engineering Interior Design
Architecture Land Surveying
Chemical Engineering Landscape Architecture
Civil Engineering Mechanical Engineering
Communication Engineering Process Engineering
Construction Management Geo Technical
Electrical Engineering Structural Engineering
Environmental Engineering Testing Lab
Forensic Engineering Other (specify below)
HVAC Engineering

8 - Project Percentage (Total must equal 100%)
Airports Parking Structures
Amusement Rides Residential - Custom
Apartments/Townhouses Residential - Subdivisions
Arenas/Stadiums Recreation
Bridges Roads/Highways
Condominiums Schools/Colleges
Dams Sewage Systems
Harbors/Piers/Ports Shopping Centers/Retail
Hospitals/Healthcare Telecommunications
Hotels/Motels Theaters
Jails Tunnels
Landfills Underground Storage Tanks
Libraries Utilities
Manufaturing/Industrial    Warehouses
Mines Wastewater Treatment Plants
Municipal Buildings Water Systems
Other (specify below) Office Buildings

9 - Claims, Suits and Demands
In the past 10 years, have any claims, suits or demands been made against the firm or its predecessor?

or any past or present principal?

Number
Total Paid/Incurred (Includes Reserves)
After inquiry, is the applicant aware of any act, error, omission or circumstance which may possibly result in a claim being made against them?


If yes, please explain in Question 11 below.

10 - Risk Management - Does your firm:
Use written in-house quality control procedures?

Have an automated master specification system?

Have an in-house program for continuing education?

Have a TQM Program?

Participate in an Organizationl Peer Review?

Number of employees who have had at least 6 hours of continuing education in past 12 months:
List the percentage of your firm's services rendered under AIA or EJCDC standard forms of agreement:

11. Explanations to "Yes" Answers:


12 - Surveyors Only
Are all registered land surveyor members of ACSM?

Services Percentage Breakdown (Total 100%):
Subdivision Work, Topographic, Construction
Stakeout and Hydrographic:
Engineering Services:
All Other Services:

Thank you for taking the time to complete this Questionnaire.
An agent will contact you as soon as possible.