June 24, 2017

Builder Risk Quote

Insured Information
Contact Email Address *
How did you hear about us? *
Insured Name *
Mailing Address
Mailing Address 2
City
State
Zip
Name of Primary Contact *
Phone Number *
Preferred Method of Contact Phone  Email
Project Information
Project Address *
Project Address 2
City *
State *
Zip *
Please select your involvement in the project? *
Is the general contractor/builder currently insured and able to provide a certificate of liability insurance? * Yes  No  N/A ?
Please provide the number of years general contractor or builder has in construction.
Name of Acting General Contractor or Builder *  ?
Type of Builders Risk *
Completed Building Value *
If currently under construction please provide the % completed and current value of completed project at this time.
Estimated Start Date Of Project *  ?
Estimated Date of Completion *
Construction Type *
Roof Type *
Number of Stories *
Square Footage *
Any Additional Interests? * Yes  No ?
If yes to above - please provide name and address of each additional interest.
Please select all utilities currently connected on project: * None  Electric  Water  Gas ?
Please provide a complete description of the project:
Choose the best description of the project to be completed: *
Click on the "?" for definition of each selection		  ?
If the project is for a remodel - please answer the following two questions:
Value of Existing Building
Value of Rennovations
* = Required Field
Disclaimer Notice - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.
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