Builders Risk Renovation Application

General Information

Project Start Date:

Project Completion Date:

Named Insured:

Phone Number

Email *

Mailing Address:

Project Location Address:

Protection Class 1-10?

or

Distance (in feet) to nearest fire hydrant:

Distance (in road miles) to nearest fire department:

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)

Existing Building

Total square feet:

Number of stories:

Year building constructed:

Date purchased:

1. Are you requesting to insure the building where the renovation is to take place?

Yes
No

If Yes: Purchase price of building excluding land:

If Yes: Fair market value of the building excluding land:

2. Is the building symmetrical, regular and simple architecture (boxes and rectangles) with no open area or atrium greater than 40,000 sq. ft?

Yes
No

If not, please describe:

3. Is the building currently occupied?

Yes
No

If yes, what percentage/square footage of the building will be occupied during the entire renovation?

Current occupancies:

If not currently occupied, how long has the building been vacant?

How long will the building be vacant after the policy begins?

Prior occupancies if vacant now:

Intended occupancies when completed:

Construction Type

Construction Type Checkboxes

Frame (ISO Grade 1) means a structure with exterior walls, floor and roof composed of combustible materials. Structures composed entirely of wood construction will be considered frame as will any structure that has metal or brick or masonry over wood frame sheathing. Additionally, any structure of mixed construction type that has, at time of completion, more than 35% of its structure consisting of frame or combustible materials (as previously described) shall also be considered frame construction.
Heavy Timber or Mill Building means having exterior walls that are of solid masonry or concrete with a minimum of two hour fire resistive rating, thick wood columns, wood beams, supports and ties. The floors are tongue and groove planks not less then 3” thick with a roof deck on heavy timber with at least a 2” thickness. These buildings were generally constructed during the late 19th century.
Joisted Masonry (ISO Grade 2) means a structure with exterior walls of masonry or composed of fire-resistive material having a fire-resistance rating not less than one hour. The floors and roof are combustible.
Non-Combustible (ISO Grade 3) means a structure with exterior walls, floors, roof and supporting structural members of non-combustible or slow burning materials. All metal buildings are most commonly found in this class. The fire resistive rating is less than one hour.
Masonry Non Combustible (ISO Grade 4) means a structure with exterior bearing walls or load bearing portions of exterior walls that are either non-combustible material with a fire resistance rating not less than one hour or are of masonry construction. Floors, roof, and interior structural members are of non-combustible or slow burning material.

Renovation

4. Describe the nature and extent of the work to be performed:

5. Has the building been renovated before?

Yes
No

If yes, please explain:

6. Will new building addition(s) be part of the work to be performed?

Yes
No

If yes, please explain, including construction type and square footage of the addition(s):

7. Renovations may be described as rehabs, renovations, or rebuilding. Generally, they involve changes that may impact the structural integrity of the building such as: - Removal or replacement of floors or structural roof members - Expansion of below grade space utilizing jacking or underpinning - Addition of floors - Sealing off stairs/installing new stair towers - Demolition of part of the structure - Removal, strengthening, or repositioning of load-bearing walls <br />Is this type of work to be performed?

Yes
No

If yes, please describe:

8. Will the renovation involve gutting the building (stripping the building’s inside of anything of value, such as pipes, radiators, and light fixtures)?

Yes
No

If yes, please describe (include dollar amount):

9. Does the project involve the removal of hazardous materials (asbestos, lead, etc.)?

Yes
No

Additional Information

10. Indicate if the following building safeguards or jobsite protection will be fully operational during the entire renovation project, which will be warranted on the policy.

Sprinkler System

Yes
No

Standpipe System

Yes
No

Central Station Burglar Alarm

Yes
No

Central Station Fire Alarm or Smoke Detection

Yes
No

The building’s water main control valve will be shut off completely at all times during which normal operations usual to the conduct of the insured’s business are not being performed.

Yes
No

A watchperson will be on duty at the premises at all times during which normal operations usual to the conduct of the insured’s business are not being performed.

Yes
No

Insured will maintain a fully functioning fence around the entire perimeter of the scheduled premises. This fence must be constructed of chain link, wood, or other suitable material, it must be at least six feet in height, and must be locked at all times when normal operations usual to the conduct of the insured's operations are not being performed.

Yes
No

All points of ingress and egress to and from the scheduled premises will be gated and locked when normal operations usual to the conduct of the insured's operations are not being performed. If a gate is un-locked, the insured will ensure guarded access to check credentials.

Yes
No

The perimeter and interior of the premises are monitored by CCTV, webcam, or other video surveillance, supervised by an independent security service at all times when normal operations usual to the conduct of the insured's business are not being performed.

Yes
No

Limits and Deductibles

Existing Building Limit:

New Construction Limit:

Soft Cost Limit:

(i.e., additional loan interest, taxes, legal fees, accounting fees, architect and engineer fees, leasing and marketing expenses, and lost rental income resulting from a covered delay)

Rental Income Limit:

Temporary Storage Limit:

of Deductibles at

Transit Limit:

Maximum Limit:

Deductible:

Waiting Period for Soft Costs/Rental Income

If Other:

Optional Coverages

Equipment Breakdown/Testing:

Yes
No

Flood:

Yes
No

Limit:

Earthquake:

Yes
No

Limit:

service@monteleoneins.com | 631-544-4000

Builder’s Risk Renovation Application