Builders Risk Insurance Quote Please enable JavaScript in your browser to complete this form.APPLICANT INFORMATIONFirst Name Insured: *FirstLastMailing Address:Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeOther Named Insureds:Partnership/Corporation/Individual:Years in Business:Description of Operations:Who is General Contractor (If not Named Insured)? *What is the General Contractor’s Address?What is the General Contractor’s Website?What is the General Contractor’s Experience? How Many Years?(if needed please ask)How many projects per year does your General Contractor Have?(if needed please ask)Inspection Contact (Name): *FirstLastPhoneEmail *Additional Interests (include names and interest such as loss payee, mortgagee, etc.):GENERAL POLICY INFORMATIONEffective Date/Expiration Date:Billing (Agency or Direct):Payment Plan:UNDERWRITING INFORMATION1. Estimated Project Start Date: End Date: (If project already begun, what % is now complete?)2. Project address:Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code3. ISO Public Protection Class:4. Description of project including intended occupancy upon completion:5. Construction Type of the building (see appendix for descriptions of ISO construction types):CSP 1 FrameCSP 2 Joisted MasonryCSP 3 Non CombustibleCSP 4 Masonry Non CombustibleCSP 5 Modified Fire ResistiveCSP 6 Fire ResistiveIf CSP 7 old style “Mill”/Heavy Timber or Mixed Construction (please describe specifically)Please describe specifically:6. Number of stories (if more than one building to be covered, please provide details on each building):One-storyTwo-storyMulti-story (others)Please provide details:7. Type of Construction:New ConstructionRenovation/Rehab (Please complete Rehab/Reno Supplemental)Reporting Policy (Please complete Reporting Supplemental)Exposures:Describe exposures from surrounding structures within 100 feet:LIMITS REQUESTEDCoverage & Limit Hard Costs LimitDelay in Completion ApplicableYesNoLimitLoss of Rents ApplicableYesNoLimitBusiness Income Including Extra Expense ApplicableYesNoLimitProperty in Transit ApplicableYesNoLimitProperty in Storage ApplicableYesNoLimitEarthquake ApplicableYesNoLimitEarth Movement ApplicableYesNoLimitFlood ApplicableYesNoLimitMechanical Breakdown and Testing ApplicableYesNoLimitOther Coverage Requirement Applicable (Describe):YesNoLimitPlease describe:DEDUCTIBLES REQUESTEDDeductibleLoss of Rents and/or Business Income Including Extra ExpenseEarthquake/Earth MovementMinimum $25,000Flood CoverageMinimum $25,000Mechanical Breakdown and Testing8. Who is General Contractor (If not Named Insured)? *FirstLast9. What is the General Contractor’s Address?Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code10. What is the General Contractor’s Website? 11. What is the General Contractor’s Experience?12. Has the General Contractor had any prior Builder’s Risk losses?YesNoa. If Yes, please describe loss(es):13. Number of stories (if more than one building to be covered, please provide details on each building):One-storyTwo-storyMulti-story (others)Please provide details: 14. Total Square Footage (If more than one building to be covered, please provide details on each building): Contractor’s the Construction 15. Which of the following types of physical protection will be provided? • Is the project completely fenced? Is the project completely fenced?YesNo• Is the project well lit? Is the project well lit?YesNo• Is the project protected by camera or video monitoring? Is the project protected by camera or video monitoring?YesNo• Will the project be protected by central station burglar alarm prior to completion? Will the project be protected by central station burglar alarm prior to completion?YesNo• Will the project be protected by central station smoke/fire detection prior to completion? Will the project be protected by central station smoke/fire detection prior to completion?YesNo• Is the project near operable fire hydrant? Is the project near operable fire hydrant?YesNo• Will project have charged standpipes or active automatic sprinkler protection during construction? Will project have charged standpipes or active automatic sprinkler protection during construction?YesNoExposures — please comment on any applicable “Yes” response: • Will temporary heat be required during the course of construction? Will project have charged standpipes or active automatic sprinkler protection during construction? (copy)YesNoComment/Controls • Hoisting, rigging or lifting required during construction? Hoisting, rigging or lifting required during construction?YesNoComment/Controls • Construction to use unique design or new construction methods (left slab, tilt up, other)? Construction to use unique design or new construction methods (left slab, tilt up, other)?YesNoComment/Controls • Structure built on filled site? Structure built on filled site?YesNoComment/Controls • Structure(s) to be occupied during the course of construction? Structure(s) to be occupied during the course of construction?YesNoComment/Controls • Will there be hot work performed on this project? Other Exposure (Describe):YesNoComment/Controls • Other Exposure (Describe): Please describe:16. Will the project be conducted in multiple phases? YesNoDescribe phases:17. Do you need “permission to occupy” coverage? YesNoDescribe exposure:18. Please comment on any other interest that needs to be covered by the Builders’ Risk Policy: The following Additional Coverages are provided up to the limits shown. Please advise if greater limits are desired. Additional Coverage & Policy Limit Business Personal PropertyLoss Adjustment ExpenseConstruction Trailers and ContentsContract PenaltyEmergency Removal to Preserve PropertyExpediting ExpensePolice and Fire Department ChargesSewer and Drain Back UpRewardsPollutant Clean UpFire Suppression Equipment Recharging CoverageValuable Papers and RecordsFire Suppression Equipment Recharging CoverageAdditional Debris Removal• If multiple buildings, please provide a plot plan and time line for construction • Please provide copies of signed leases, contracts or other supporting documentation Submit
