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Course of Construction/Builders Risk

Please fill out the form below. You may also fill out our short form by clicking here.

General Information
How did you hear about us? *
BIA Chamber of Commerce
Current Client Email
Google Yahoo
Mailer Yellow Pages
Referral: Website:
Other:  
Named Insured:
Contractor's License #:
Owner's Name:
Contact's Name:
Phone: *
 Fax:
Cell:
Email Address: *
 Preferred method of contact: *
Phone Fax Email Mail
Address Information
Mailing Address
Street: *
City: *
State: *
Zip: *
 
Premise Address
Street:
City:
State:
Zip:
Business Entity: *
Sole Proprietorship Partnership Corporation LLC Other:
Construction Information
Construction Location/Address:
Project Cost: Estimated Job Length:
Intended Occupancy: Total Area (in square feet):
Description of work to be done
Residential Commercial New Construction Remodel
General Contractor Information
Name of General Contractor:
(if different)		 General Contractor's License #:
Contact Name and Phone:
Property Information
      Options       Description
Yes No Will the insured be the Owner/Occupant?
Yes No Will the construction site be fenced?
Yes No Will the construction site be lit?
Yes No Has the brush been cleared (if applicable)?
Yes No Is this a mid-term project?
  If yes, how much has been completed already? %
Yes No Does the insured plan to sell part or all of the completed project?
Yes No Is this a Rehab/Renovation?
  If yes, what is the value of the exisiting structure?
  What is the value of the work to be completed?
  Describe the Renovation:
  Esitmated Length of the Job?
  Which Security Measures are in use?
None
 24 hour guards
 Guard Patrol
 Watchman
Locked Structure for building materials
 Fire Extinguishers
Other
Yes No Has the insured had any claims (or losses) during the last five years?:
If Yes, provide details:
Property Mortgagee/Loss Payee Information
Name of Bank or Lending institution:
Bank/Lender's Address:
What is the above to be named? Loss Payee
Additional Insured
Mortgagee
Additional Comments
Comments:
Legal Terms
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Print Your Initials: *
This is not an application, it is only a preliminary info sheet for a quote. Additional information may be required.
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