Builders Risk Questionnaire

Please enter names

Enter the Owner's Name and the Contractor's name Below.

Owner's Name

First Name Last Name

Contractor's Name

First Name Last Name

Email

Phone Number

Are you the Owner, Contractor or Owner/Contractor?

Owner

Contractor

Owner/Contractor

Other

Insurance Policy Mailing Address

Street Address Address Line 2 City State ZIP Code

Policyholder FEIN

Project Information

Project Start Date

Construction Project Physical Location

Street Address Address Line 2 City State ZIP Code

Estimated length of project? (Please factor in customary job delays)

Description of Project and work to be completed.

Is this a New Construction or Remodeling/Renovation?

New Construction

Remodeling/Renovation

Other

Will any structural changes be made during course of construction?

Yes

No

What is the total job contract value?

Change Order percentage (Example 20% or 30% additional cost to job contract value to account for change orders)

Any temporary storage locations?

Yes

No

If so, what is the value of materials or equipment being stored at temporary location?

Any owned materials or equipment being transported?

Yes

No

If so, what is the maximum value?

Coverage and Limits

Soft Costs Limit

Soft Cost Expense Types: Advertising & promotional, Interest on const loan, Architect, Engineer & Consultant Fees, Real Estate & Property Tax Assessment, Commissions or fees for the renegotiation of leases, Insurance premiums, Legal & Accounting fees, Fees for License & Permits.

Equipment Breakdown Coverage

Testing Coverage

Loss of Rents Limit

Loss of Revenue Limit

Flood Coverage Limit

Water Backup Coverage

Earthquake Coverage Limit

Green Construction Endorsement

Any model home exposure?

To better assist with the Builders Risk Proposal, please upload any Construction Plans, Site Drawing, Engineering Plans, etc.

Max. file size: 300 MB.

By clicking SUBMIT you consent to receive SMS messages. Messages and Data rates may apply. Message frequency will vary. Reply Help to get more assistance. Reply Stop to Opt-out of messaging

This field is for validation purposes and should be left unchanged.

Builders Risk Questionnaire

Submit our builders risk intake form and one of our agents will be in touch.