Have there been any losses in the past 3 years? If so, please explain:
Mobile Equipment Amount?: $
Any Transportation of Animals?
In the past 3 years, has any license investigation or action been taken against you or an employee? If yes, please provide name(s), date(s), and explain:
Are any services provided to animals in zoos, circuses, carnivals, rodeos, theatrical or other show enterprises?
Are any of the following operations performed? Training or obedience schools Commercial cattle/hog confinement operations Prize Livestock Breeding of laboratory animals Animal Auctions
If yes, please explain:
Veterinarians, Technicians, Drivers: # of Employees at Each Location
Veterinarians, Technicians, Drivers: Annual Payroll
Clerical: # of Employees at Each Location
Clerical: Annual Payroll
Employers Liability Limits $500,000/$500,000/$500,000 $1,000,000/$1,000,000/$1,000,000
Owners Included Excluded
If Excluded, provide: Name, Annual Payroll, % of Ownership, and Duties
