Instructions for Ultra Contractors / Specialty Services Mail Audits

Use the information below to help you fill out the specific sections of your audit form.

If you have any questions, please call our service center at 1-800-422-6340. Definitions of terms used in these instructions can be found in the Premium Audit Glossary.

Step 1 – Description of Business Operations

Please present a clear picture of your business operations. If you have multiple entities, please describe each one. If there isn’t enough space, please write a full description on a separate sheet of paper and attach it to the document. Here are some examples:

Entity

Check the box that represents your organizational structure.

Owners/Officers Names	List all executive officers, owners, and partners.
Title	State the corresponding title for each person. Please be specific. Avoid terms such as "manager" or "administration". Describe the actual work duties of each person. For example, indicate if an individual is a supervisor of a work crew, in charge or outside sales, or has office duties.
Total # of Days Worked in Policy Term	Record the actual number of days each owner worked.
Type of Work Performed	If the individual splitsduties between operations, give the percentage of time spent in each activity.

Step 2 – Employees and Laborers

Name of Employees or Laborers	List each person who worked for you during the policy term, including any employees who were terminated during the policy term. Also include leased employees and contract laborers (i.e. those without insurance who work directly for you but are not listed on your payroll records).
Total # of Days Worked in Policy Term	Record the actual number of days each person worked. Any part of a day represents a day.
Type of Work Performed	Describe the actual work each person performed (e.g. carpentry work, field supervisor of carpenters, bookkeeping duties).

Total Receipts

Please enter receipts (gross sales) for your business for the policy term. This is for informational purposes only. We do not use it for billing purposes. We request this information to ensure that you are in the most appropriate general liability program.

Total Payroll

Please enter the total gross payroll for your business for the policy term. This is for informational purposes only. We do not use it for billing purposes. We request this information to ensure that you are in the most appropriate general liability program.

Do You Use Leased Employees?

Many companies lease their employees from an employee leasing operation. Since the employees work under your direction and control, they are considered your employees for liability insurance purposes and are to be included in your mail audit. Leasing companies do not cover direct liability exposures while they are working for you. This coverage is different than the Workers Compensation coverage that the leasing company may or may not provide. If you have leased employees, answer "Yes" to the question and include them in the employee section.

Step 3 – Subcontractors

List any subcontractors that worked for you during the policy term. Subcontractors differ from contract laborers in that they are independent and are not under your direct control while completing their work.

They should provide you a current General Liability certificate of insurance. If they do not provide you with a current certificate of insurance, include them as employees on your policy. It's important to know that you need a new certificate for each new policy term, as certificates only cover a 12-month period.

Name of Subcontractor	List each subcontractor you employed during the policy term.
Type of Work Performed	Indicate the exact type of work the subcontractor performed.
Total # of Days Worked in Policy Term	Complete only if the subcontractor did not provide you with a current certificate of insurance.
Certificate of Insurance	(Yes or No)
Total Amount Paid	Provide the total amount you paid to each subcontractor. We will not use this for billing purposes.

Step 4 – Contact Information

Please provide your contact information, including your email address, then sign and date the form.

We’ve also included the Premium Audit Release of Information form. Safeco does not share the audit worksheets with your agent without your signed consent. We will keep the completed forms on file should your agent request a copy of your worksheets.