1. Did you get a copy of the auditor's worksheets?	Yes No
2. Was the audit conducted at the accountant or bookkeeper's office?	Yes No
3. Did the insurance company change your basic classification?	Yes No
4. Was your experience modification increased during the policy period?	Yes No
5. Were charges made for uninsured subcontractors or owner-operators?	Yes No
6. Does the audit include a charge for paid commissions?	Yes No
7. Did you receive a large additional or return premium? (You may be entitled to more!)	Yes No
8. Did your state implement a rate change?	Yes No
9. Were credits that were on last year's policy removed from your current policy?	Yes No
10. Does your policy have fewer than 4 classifications?	Yes No
11. Are you a contractor involved in several types of work but not all of them are shown on your policy?	Yes No
12. Was your policy cancelled or rewritten with a different effective date in the last 4 years?	Yes No
13. If you are an executive officer of the corporation, were your wages assigned to a high rated classification?	Yes No
14. Are you a contractor involved in a Wrap-up construction project?	Yes No
15. Were you awarded any contracts under the Davis-Bacon Act?	Yes No