BUILDERS RISK

Please complete the survey to the best of your ability. We aim to cover all aspects comprehensively.

First Name *

Last Name

Email *

Phone *

Zip/Postal code

City

State

COMPANY INFORMATION

Company Name *

Property Address *

License # *

License Classification *

Entity of Company *

Applicant SSN *

Applicant DL # *

Street Address *

Apt/Suite

Value of Existing Structure

Value of Work Being Performed

Construction Type

Wind & Hail Coverage? *

Yes

Years in Business *

Number of Losses in the last 5 years at the location where the construction is planned. *

Any Prior Coverage? *

Yes

Has the scheduled property address had any prior Builder's Risk coverage? *

Yes

INSURANCE DETAILS

Period of Insurance / Duration of Project. *

Desired Effective Date *

PROJECT DESCRIPTION

Complete descriptions of operations for the project for which you are currently applying for insurance. *

Description of Property Use Prior to Construction. *

Is the Applicant Mailing Address the same as the physical location? *

Yes

PROPERTY INFORMATION

Is the Property Commercial or Residential? *

Commercial

Residential

Square Footage *

Number of Floors *

Protective Safeguards