Carrier:
Test Insurance Company
111 Main Street
Any City, AL 35801
Agent:
TN Ins Agcy Inc
Policy Information:
GL WRAP-UP 1234567
General Liability
04/01/2014 to 04/01/2015
Audit ID: 184476
Audit Method: Physical
Audit Complete Type: Regular
Insured Name and Address:
ABC Construction Co Inc
123 Any St
Nashville, TN 37202
Generated:
12/16/2015 3:24 PM
Completed By:
Test Auditor
Wilkinson Insurance Services
5650 Sanderson Street Suite Q
Huntsville, AL 35805
12/16/2015
Audrey: 4.1, PID: 52
Description Of Operations ... Audit 184476
Legal Entity: CORPORATIONPolicy No(s): GL WRAP-UP 1234567Policy Period: 04/01/2014 to 04/01/2015

ABC Construction Co Inc is operating as a corporation in Nashville, TN.

They are a specialty contractor doing concrete construction work for new commercial construction projects. They pour concrete driveways, foundations/slabs, parking lots and sidewalks. There is no separation of payroll between the foundation/slab work and the other types of concrete work. All field employees listed as concrete are building and taking apart forms, pouring concrete, finishing concrete, providing job site clean up, etc. Job site foremen are directly overseeing all aspects of the concrete work in the field. All of these persons are included in the 91560 class code.

Executive supervisors are included in the 91580 class code and are performing indirect supervision through job site foremen. They are working in the office and visiting job sites periodically to meet with the foremen, assist in job site problems, hire subcontractors.

Exposure for clerical and outside sales personnel has been excluded. They are not working at the job sites and performing duties consistent with these areas.

Premium overtime was paid and deducted from the exposure.

Labor is performed by both direct employees and subcontractors. All subcontractors provided proper COI’s covering the audit period and payments of the subcontractors. Due to the large number of subs, permission was granted from Jane Smith at Test Insurance to lump all of the subs as one figure. All COI’s were properly verified and adequate G/L limits were in place.

There were wages paid under an OCIP project at the DOT facility in Nashville @ 789 Project Pkwy, Nashville, TN. These wages have been excluded per separate coverage as verified with Joan Smith @ Marsh (OCIP Insurance Company, policy number AB1-234-567890-123). The phone number for Joan is 615-123-4567. The insured worked on this project all year long. Weekly wage reports filed by the insured for the OCIP project were reviewed to exclude wages paid under the OCIP project.

Officer 1 (president) is active in sales and as general office manager. He is excluded from the exposure.  Officer 2 (S/T) is active as executive supervisor providing indirect supervision through job site foremen. He is included in the exposure at the G/L maximum in the 91580 class code.

Exposure Summary ... Audit 184476 ... 04/01/2014 to 04/01/2015 ... Policy GL WRAP-UP 1234567
Insured: ABC Construction Co IncPolicy Period: 04/01/2014 to 04/01/2015
 Audit Period: 04/01/2014 to 04/01/2015
Policy No(s): GL WRAP-UP 1234567Auditor: Test Auditor

State Code Classification Loc Basis Mod Exposure
TN 91560 Concrete Construction Payroll 1,405,960
TN 91580 Contractor-Executive Supervisors or Superintendents Payroll 331,299
Total Exposure: 1,737,259
Subcontractors Exposure Summary
TN 91585 Contractors-Subcontracted Work-Buildings NOC Total Cost 1,198,600
Total Exposure: 1,198,600
Grand Total Exposure:2,935,859
Principal ... Audit 184476
 
Officer 1 President Excluded   P/R: 0.00
Start/End: to Min: 0 Max: 0  
  TN
Audit Period: to Total Amt: 96,620  
Operations Manager - Office only
 
Officer 2 S/T Included   P/R: 1.00
Start/End: 04/01/2014 to 04/01/2015 Min: 5,200 Max: 26,000  
  TN 91580 Contractor-Executive Supervisors or Superintendents
Audit Period: 04/01/2014 to 04/01/2015 Total Amt: 96,620 Included At: 26,000  
Executive Supervisor
Exposure Recap ... Audit 184476 ... 04/01/2014 to 04/01/2015
State Code Classification / Name Loc Basis Mod Exposure
TN91560 Concrete Construction Payroll 
  Concrete - 30+ Duties: Concrete - 30+ 1,775,092
    Prem OT Credit @ 1.5 (106,362)
  Emp 10 Duties: Foreman 36,408
    Prem OT Credit @ 1.5 (2,689)
  Emp 11 Duties: Foreman 65,192
    Prem OT Credit @ 1.5 (5,845)
  Emp 8 Duties: Foreman 39,205
    Prem OT Credit @ 1.5 (3,110)
  Emp 9 Duties: Foreman 31,449
    Prem OT Credit @ 1.5 (1,291)
  OCIP Concrete Duties: OCIP Concrete 0
    OCIP Concrete (422,089)
  ---------------
1,405,960
==========
TN91580 Contractor-Executive Supervisors or Superintendents Payroll 
  Emp 1 Duties: Executive Supervisor 73,480
  Emp 2 Duties: Executive SupervisorExecutive Supervisor 67,710
  Emp 3 Duties: Executive Supervisor 60,010
  Emp 4 Duties: Executive Supervisor 62,410
  Emp 5 Duties: Executive Supervisor 29,256
    Prem OT Credit @ 1.5 (1,070)
  Emp 6 Duties: Executive Supervisor 39,431
  Emp 7 Duties: Executive Supervisor 14,974
    Prem OT Credit @ 1.5 (136)
  OCIP Exec Sup Duties: OCIP Exec Sup 0
    OCIP Exec Sup (40,766)
  *Officer 2 Duties: Executive Supervisor 26,000
  ---------------
331,299
==========
TNEXCLUDED    
  *Officer 1 (Excluded) Duties: Operations Manager - Office only 96,620
  ---------------
0
==========
TNEXCLUDED   Payroll 
  Emp 12 (Excluded) Duties: Office Manager 39,440
  Emp 13 (Excluded) Duties: O/S Sales 25,700
  ---------------
0
==========
Total Exposure: 1,737,259
Subcontractors Exposure Recap
TN91585Contractors-Subcontracted Work-Buildings NOCTotal Cost 
  Insured Subs - 47   1,198,600
 ---------------
1,198,600
==========
Total Exposure: 1,198,600
Grand Total Exposure: 2,935,859
Worksheet3 ... Audit 184476
Name
Code Gross 4/1 - 4/1 Prem OT Credit @ 1.5 OCIP
* Officer 1
EXCLUDED 96,620 96,620    
* Officer 2
91580 96,620 96,620    
Emp 1
91580 73,480 73,480    
Emp 2
91580 67,710 67,710    
Emp 3
91580 60,010 60,010    
Emp 4
91580 62,410 62,410    
Emp 5
91580 29,256 29,256 (1,070)  
Emp 6
91580 39,431 39,431    
Emp 7
91580 14,974 14,974 (136)  
Emp 8
91560 39,205 39,205 (3,110)  
Emp 9
91560 31,449 31,449 (1,291)  
Emp 10
91560 36,408 36,408 (2,689)  
Emp 11
91560 65,192 65,192 (5,845)  
Emp 12
EXCLUDED 39,440 39,440    
Emp 13
EXCLUDED 25,700 25,700    
Concrete - 30+
91560 1,775,092 1,775,092 (106,362)  
OCIP Concrete
91560 0     (422,089)
OCIP Exec Sup
91580 0     (40,766)
Totals:
  2,552,997 2,552,997 (120,503) (462,855)
Adj:
  (583,358)      
Exposure:
  1,969,639      
Subcontractors ... Audit 184476
NameCertificate DetailExposure
Insured Subs - 47
Carrier: COI's verified Cost: 1,198,600
Policy Num: Materials: 0
Contract Period: 04/01/2014 to 04/01/2015 % Adjustments: 0
Limits:  
Audit State: TN
91585 Contractors-Subcontracted Work-Buildings NOC 1,198,600
General Liability Workers ... Audit 184476 ... 04/01/2014 to 04/01/2015
State Code / Name Classification Loc Basis Mod Adj Exposure
TN 91560 Concrete Construction Payroll   1,405,960
  Concrete - 30+ Prem OT Credit @ 1.5 106,362  
  Emp 10 Prem OT Credit @ 1.5 2,689  
  Emp 11 Prem OT Credit @ 1.5 5,845  
  Emp 8 Prem OT Credit @ 1.5 3,110  
  Emp 9 Prem OT Credit @ 1.5 1,291  
  OCIP Concrete OCIP Concrete 422,089  
    Adjustments Total: 541,386  
TN 91580 Contractor-Executive Supervisors or Superintendents Payroll   331,299
  Emp 5 Prem OT Credit @ 1.5 1,070  
  Emp 7 Prem OT Credit @ 1.5 136  
  OCIP Exec Sup OCIP Exec Sup 40,766  
  *Officer 2 Over inclusion Max 70,620  
    Adjustments Total: 112,592  
TN Excluded   96,620  
TN Excluded   Payroll 65,140  
Total Adjustments / Exposure: 815,738 1,737,259

Worksheet Gross Total Verification Source Total Audit Total
2,552,997 2,552,997 2,552,997
General Information ... Audit 184476
Insured: ABC Construction Co Inc Phone: 615-123-4567
  123 Any St Fax:
  Nashville, TN 37202 Mobile:
  Contact: Jane Doe Email:
Records Obtained From: Jane Doe
Phone: 615-123-4567
  123 Any St Fax:
  Nashville, TN 37202 Mobile:
    Email:
Verification Source Record
ABC Construction Co Inc
Verification Source Record: 941, State, and Computer Reports
Employer's Federal ID No.: 12-3456789
1st Quarter 2015: 636,051
2nd Quarter 2014: 455,170
3rd Quarter 2014: 899,764
4th Quarter 2014: 562,012
Subtotal: 2,552,997
Total: 2,552,997
General Liability Checklist
15 day rule observed for the audit period? YES Invoices reviewed for materials credit for uninsured subs? N/A
If employees were lumped, did you provide # of employees? YES Was the total subcontractor cost considered? YES
Did the subcontractors have adequate liability limits? YES    
General Information Checklist
Are the records computerized? YES What is the condition of the records? GOOD
Were payroll journal records examined? YES Were general ledger records examined? YES
Was the check book examined? NO Were income tax return records examined? NO
Were cash disbursement records examined? NO Were 941 Returns examined? YES
Were U/C Returns examined? YES Were Certificates of Insurance examined? YES
Were 1099 records examined? NO What other records were examined? NONE
All locations/addresses shown verified/discussed on audit? YES Was the profit & loss statement reviewed? YES
Notes ... Audit 184476 ... Policy GL WRAP-UP 1234567
Test Insurance Company
Any City, AL
ABC Construction Co Inc Nashville, TN
Test Auditor

Percent difference between actual and estimated exposures (negative if est. > act.):
State Code Classification Prem Basis Location Est Act Pct Diff
TN 91580 Contractor-Executive Supervisors or Superintendents Payroll 204,610 331,299 61.92%

Exit Interview conducted on 12/16/2015 at 12:47 PM
  Interviewee: Emp 12 Title: Office Manager  
  Records were
obtained from:
Title:  
 

Notes to Audit Department

Number of employees: 67.

Gross revenue: $7,920,596.

There was an increase in exposure for code 91560 due to the insured obtaining more work in this period.

There were wages paid under an OCIP project at the DOT facility in Nashville @ 789 Project Pkwy, Nashville, TN. These wages have been excluded per separate coverage as verified with Joan Smith @ Marsh (OCIP Insurance Company, policy number AB1-234-567890-123). The phone number for Joan is 615-123-4567. The insured worked on this project all year long. Weekly wage reports filed by the insured for the OCIP project were reviewed to exclude wages paid under the OCIP project.

Additional time was charged for time spent detailing wages for 91580 and the foremen for 91560.  Also time was needed to verify OCIP information and review certified payroll reports to make applicable deductions.

Signature Form ... Audit 184476
Insured: ABC Construction Co Inc
Policy No(s): GL WRAP-UP 1234567 Policy Period: 04/01/2014 to 04/01/2015
 
The undersigned acknowledges that a representative of was present on the date below for the purpose of conducting an insurance audit for the policy indicated above.
 
Insured's Authorized Representative: Emp 12
Note: The signature is only viewable with Internet Explorer.
Signed: 12/16/2015 12:49:00 PM

A copy of this audit for the agent of record is approved.

Auditor: Wilkinson Insurance Services
5650 Sanderson Street Suite Q Huntsville, AL 35805