WEST CONGRESS
Send new and renewal submissions to: submissions@westcongress.com
SECURITY GUARD and PRIVATE INVESTIGATIVE OPERATIONS
| Agency Name: | ||
| Agent: | ||
| Address: | ||
| E-mail Address: | ||
| Phone Number: | ||
Section 1 – Applicant Information
1.
2.
Additional Locations (if any):
a.
b.
c.
d. If additional space is necessary, please provide additional worksheet.
Please list any prior / discontinued company names:
3.
4.
(i) Main Applicant
Contact:
Contact:
Tel No.:
Email:
Email:
(ii) Inspection/Audit:
Tel No.:
Email:
Email:
5.
6.
a. Date Legal Entity Established:
Years’ experience in Security field:
Years’ experience in Security field:
b. Owner Information / Names:
Owner 1: Ownership%:
Owner 2: Ownership%:
Owner 3: Ownership%:
Owner 4: Ownership%:
Owner 5: Ownership%:
c. Please describe duties of the Owner(s) – Advise whether any owners have active guard posts / conduct investigations:
d. Please describe background / experience of the principals of this organization:
e. Is Applicant involved in any other operations?
If Yes, please describe:
If Yes, please describe:
f. Any other states of operations:
g. Is the Company a division of a larger corporation or a subsidiary?
h. Has any carrier cancelled or non-renewed Applicant’s business? (Not applicable in Missouri)
If Yes, for what reason?
i. Has the Applicant had any lapse in prior coverage?
If Yes, for what reason? Dates of Lapse?
j. Are you aware of any incidents, conditions, circumstances, complaints, or suspected matters in the past 5 years which may result in claims against applicant?
k. What are your incident reporting procedures?
l. How long are your records kept?
7.
Provide the names of Applicant’s five largest clients and a description of your duties for them:
Provide the names of Applicant’s five largest clients and a description of your duties for them:
(1)
(2)
(3)
(4)
(5)
(2)
(3)
(4)
(5)
8.
Does your company have the following in place:
Does your company have the following in place:
9. Employee Selection and Training
a. Pre-employment Screening Procedure (check all applicable):
b. Training Program Includes (check all applicable):
c. Training – Please describe how field employees are trained (i.e., on-the-job, formal training program):
d. Any Trade Association Membership(s) held?
e. Please indicate all licenses held by you (with license numbers) and your employees:
f. Officer Training – If required by the state, how many hours does the Applicant participate in annually?
10. a. Staff, Payroll and Revenue
| Classification | Total # of Staff | Full Time # | Part Time # | Annual Payroll | Annual Sales |
|---|---|---|---|---|---|
| Owners / Executives / Clerical / Sales | $ | $ | |||
| Supervisors (Active / Field) | $ | $ | |||
| Supervisors (Admin / Monitor only) | $ | $ | |||
| Employed Armed Guards | $ | $ | |||
| Employed Unarmed Guards | $ | $ | |||
| Employed Investigative Staff | $ | $ | |||
| Independent Subcontractors (Guard) | $ | $ | |||
| Independent Subcontractors (Investigator) | $ | $ | |||
| Total | $ | $ |
b. Annual Number of Billable Hours:
Armed Guard Hours:
Unarmed Guard Hours:
Armed Investigator Hours:
Unarmed Investigator Hours:
Average Length of Employment:
11. Security Officer Billing:
Average hourly Guard billing rate:
Average hourly Guard pay rate:
Average hourly Supervisor pay rate:
12. SECURITY GUARD OPERATIONS
Please provide breakdown of operations by following categories that are applicable:
If no Security Guard Operations, check here and move down to 14.
| Operations | Armed Payroll | Unarmed Payroll |
|---|---|---|
| Airports / Seaports | $ | $ |
| Alarm response – Describe | $ | $ |
| Armored Car / Courier Services (Other than Marijuana) | $ | $ |
| Banks | $ | $ |
| Banquet facilities | $ | $ |
| Bars, Lounges, Night Clubs, Gentlemen’s Clubs | $ | $ |
| Bodyguarding / Executive Protection – High Profile Individuals (athletes, entertainers, celebrities etc.) | $ | $ |
| Bodyguarding / Executive Protection – Low Profile | $ | $ |
| Bus Stations / Train Stations / Mass Transit | $ | $ |
| Canine – Handler Payroll | $ | $ |
| Car Dealerships | $ | $ |
| Casinos | $ | $ |
| Churches or other Religious Institutions | $ | $ |
| Construction Sites | $ | $ |
| Convenience Stores / Liquor Stores | $ | $ |
| Conventions / Trade Shows | $ | $ |
| Fast Food Establishments | $ | $ |
| Golf Tournament / Tennis Tournament | $ | $ |
| Government Contracts Federal / State/ Municipal buildings – office buildings | $ | $ |
| Government Contracts – Other – Describe | $ | $ |
| Hospitals – No ER posts | $ | $ |
| Hospitals – ER posts or patrol | $ | $ |
| Hotels / Motels | $ | $ |
| Janitorial | $ | $ |
| Malls – Outside / Common Areas ONLY | $ | $ |
| Malls – Loss Prevention / Inside Stores | $ | $ |
| Manufacturing Plants | $ | $ |
| Marijuana – Transportation of Cash or Product | $ | $ |
| Marijuana – Cultivation Sites | $ | $ |
| Marijuana – Processing Centers or Warehouses | $ |