BUILDERS RISK / COURSE OF CONSTRUCTION FOR LARGE AND SMALL CONTRACTORS |
Welcome to our Builders Risk / Course of Construction for United States Business Operations. States in we currently write insurance in Arizona, California, Idaho, Iowa, Nevada, Oregon and Texas. To learn more about our Types of Builders Risk Plans Click Here...  |
PLEASE PROVIDE INFORMATION ABOUT THE "INSURED"  |
| Contact Name |
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Company Name |
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Business Entity form |
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Primary Phone
(###) ###-#### |
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Fax Number |
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E-mail |
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| Insured's Name |
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Description of Insured |
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Website address |
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| Insured's Mailing address |
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City |
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State |
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Zip |
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PLEASE PROVIDE INFORMATION REGARDING THE BUILDER |
| Is Builder's name different than Insured? If yes please provide name and mailing address. |
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Builders name and mail address: |
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| Builder's Primary Trade |
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The number of structures built or remodeled in the pas 12 months is: |
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| Add Builder as Additional Insured? |
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The number of structure PROJECTED for the next 12 months |
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| Does Builder/GC/Remodeler have at least two years experience |
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| Have you ever had any single loss over $10,000 in the last 3 years? Exliain if yes. |
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PROPERTY - STRUCTURE LOCATION INFORMATION FOR STRUCTURE TO BE INSURED IF ELIGIBLE |
| address,lot or Apn |
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Type of project |
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| City, State and zip code |
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Type of property |
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| County |
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Requested effective date |
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Fire Protection Class |
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| Is there a fire hydrant withing 1000'? |
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Is there a Fire Depatement withing five road miles? |
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| Policy Period * |
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New Construction one year minimum. Premim is fully earned.
Remodeling periods are one year, six months or nine months. |
| Is Contractor insureing any other building within 100 of this structure? If yes please provide value and name of insurance carrier: |
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Construction Materials
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| If existing structure what is the year built? |
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Number of stories |
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Is there a sales contract on structure |
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| Will the structure be occupied during construction? If yes by who? |
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| Has the project started? |
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If yes, percentage completed |
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Date started if applicable |
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| Will all renovations or will project start in the next 60 days? |
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Estimated length of project |
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IF THIS IS NEW CONSTRUCTION COMPLETE THIS SECTION, IF A REMODEL SKIP TO NEXT SECTION |
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IF THIS IS A REMODEL ONLY CHOOSE THE SCOPE OF WORK |
| Remodeling
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Remodel / Minor Structural
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Restructuring
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| Please describe the type of work to be done |
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1. Amount of renovation/improvements
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2. Existing building(s) or structure(s) amount |
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| 3. Total completed value of all covered property is? (Must be 100% on the "new" construction if the replacement cost endorsement is to be issued. The existing is issued on an ACV basis. |
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4. Better green endorsement |
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5. Change order endorsement?
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6.Will the existing structure be insured by another policy during construction? |
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| 7. Does the building have an operable sprinkler system |
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8. Is the existing structure listed on any historical registry or subject to a historical society regulation? |
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| 9. Has the existing structure been moved or will it be moved as part of this project |
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10.Any previous losses at this location as a result of quake, flood, wind, fire or vandalism? |
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OPTIONAL INFORMATION - MORTAGEE - TITLE COMPANY |
| Mortgagee Name and Address |
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City |
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Phone |
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fax |
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| Loan number |
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| Title Company Name and address |
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City |
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Phone |
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fax |
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| Escrow number |
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Title Officer |
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Officer's email |
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Enter Security Code:
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