Builders Risk Insurance Quote

Business / General Contractor Name *

Project Address *

Mailing Address (if different) (not required)

The applicant is (check all that apply) (not required)

Business Structure (not required)

Years in Business (not required)

Is the applicant a licensed general contractor? (not required)

Yes No

Type of Project *

Type of Policy (not required)

One-shot policy Reporting form policy

Will the contractor or owner be insuring more than one building / structure on this policy? (not required)

Yes No

Construction Material (not required)

Protection Class (current ISO Public Protection Classification) (not required)

Protection class confirmation (check all that apply) (not required)

Contact your fire department for this if you are in a rural area with a volunteer fire department or you pay fire dues Property is within 5 road miles of the responding fire station and within 1,000 feet of a creditable water supply

Number of Stories (if over 7, underwriter approval required) (not required)

Square Footage (INCLUDES basement) (not required)

Type of Property (not required)

Residential (1-4 Single Family Dwellings/Units) Commercial

Intended Occupancy (not required)

Will the structure be occupied at any time during the policy term? (not required)

Yes No

Is this a model home? (not required)

Yes No

Original Year Built (existing structure) (not required)

Year the Roof Was Last Updated (not required)

Is the structure modular? (if yes, underwriting approval required and modular questions will be asked) (not required)

Yes No

Does it have a continuous masonry foundation and a shingled roof? (not required)

Yes No

Will this project involve installation of solar? (not required)

Yes No

Total Completed Value of Any One Structure ($ - greater than $3,000,000 requires underwriter approval) *

Total Completed Value of All Covered Property ($ - greater than $3,000,000 requires underwriter approval) *

Deductible Requested (not required)

Other Deductible Amount ($) (not required)

Soft Costs to Include ($, if any - permits, architect/engineering fees, etc.) (not required)

Value of the Existing Building to Insure ($) (not required)

General Liability Limits Requested (not required)

Add $5,000 of theft coverage? (not required)

Yes No Not Sure

Policy Period (not required)

Expected Completion Date of Project (not required)

Is the builder's name different than the named insured? (not required)

Yes No

Builder's Name (not required)

Does the builder / remodeler / owner / GC have at least 2 years experience? (If no, the risk is not eligible) (not required)

Yes No

Builder's Experience (years, similar projects completed) (not required)

Number of structures / projects projected for the next 12 months (not required)

1-2 3-50 Other

How many? (not required)

Has the builder / remodeler and/or the structure itself had any single loss or damage over $10,000 in the last 3 years? (include insured and uninsured losses) (not required)

Yes No

Loss Details (not required)

Mortgagee / Lender Name and Address (if any) (not required)

Has the project started? (not required)

Yes No

Date Started (not required)

Percent Complete (%) (not required)

Has the project been dormant or delayed? If so, how long and why? (not required)

Has there been a change in the general contractor? (not required)

Yes No

Any previous damage at this location as a result of quake, flood, wind, fire or vandalism? (include insured and uninsured damages) (not required)

Yes No

Explain all losses including the peril involved, the amount of the loss and the date of the loss (if yes, underwriter approval required) (not required)

Is the job site completely fenced with gates that lock after hours? (not required)

Yes No

Height of Fencing (not required)

Is there security lighting at the job site? (not required)

Yes No

Is guard service employed on site? (not required)

Yes No

Guard Hours (weekends only, off-hours only, 24/7, other) (not required)

Are portable fire extinguishers kept at the site? (not required)

Yes No

Distance to the Nearest Fire Hydrant (feet) (not required)

Distance to the Nearest Responding Fire Department (miles) (not required)

Hazardous or flammable materials stored on site, and how they are stored (not required)

Is the renovation structural or non-structural? (not required)

Structural Non-Structural Both

Any hot work (welding, cutting, torch work, soldering, grinding)? (not required)

Yes No

Any electrical work? (not required)

Yes No

Is there an operating central station burglar alarm? (not required)

Yes No

Is there an operating central station fire alarm? (not required)

Yes No

Is the structure sprinklered, and is the system turned on? (not required)

Sprinklered - system on Sprinklered - system off Not sprinklered

Have you had builders risk coverage before? (not required)

Yes No

In the past 3 years, has any company cancelled, declined or refused similar insurance? (not required)

Yes No

Please explain (not required)

Has the applicant declared bankruptcy or been in receivership in the past 5 years? (not required)

Yes No

Date(s) (not required)

Do you have coverage now? *

Yes No

Who is your current insurance company? *

When does your insurance expire? *

Policy Effective Date (12:01 a.m. standard time at the mailing address above) *

Notes (not required)

How would you like us to contact you? (not required)

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