Commercial

Services &
Protection,
Inc.

Pool Contractor Questionnaire

3250 PTree Ind Blvd, Ste 101, Duluth, GA 30096 Phone (770) 476-9122 Fax (770) 4769394
Name of Insured:
Location:

__________________________________________________________

_________________________________________________________________

1.

Installation of above or below ground

pools?
________________________________

2.

Any installation
of spas or hot
tubs?
_____Yes
_____No

3.

Is a fence in
place around all
pools?
_____Yes
_____No
Do they install fences themselves?
_____Yes
_____No

4.

Are depth
markers
installed in
pools?
_____Yes
_____No

5.

Any installation
of diving
boards?

_____Yes
_____No
6.

How long has the Insured been in

business?
________________________________

7.

Any distribution
of pool
accessories or
chemicals?
_____Yes
_____No

8.

Any operations
other than pool
work?
_____Yes
_____No

9.

Any other services offered?

_____Yes
_____No
(such as bacteria testing, lifeguards, cleaning, water alarm installation etc.)
If so, please give details: ___________________________________________________
_______________________________________________________________________

10.

Does applicant
comply with
NSPI safety
standards?
_____Yes
_____No

11.

Does the
insured use
subcontractors?

_____Yes
_____No
If so, please indicate what percentage of work is subbed: _______%

What type of work is subcontracted?

__________________________________________
Limits of liability required of subcontractors: ____________________________________

The above statements given are true and accurate.

The applicant has not willfully concealed or misrepresented any
_______________________________ material fact or circumstance on this Questionnaire.
Applicants Signature
Date