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Builders Risk New Ground Up Construction
If a questions is not applicable, put NA in the required field in order to bypass.
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Contact Information
What Name Should Insurance Be Under?
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If you want the policy listed in a company name, enter the name here.
EIN Number
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Year Established
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Contact Name
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First
Last
Phone Number
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Email Address
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Company Type
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Individual
Corporation
LLC
Other
How did you find us?
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Choose One
Existing Client
Referral
Web Search
If other company type, explain
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Mailing Address
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Line 1
Line 2
City
State
Zip Code
Country
Start Date
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Provide the project start date here
Expected Completion Date
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# Stories
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Square Footage
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Construction Type
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Frame
Brick Veneer
Joisted Masonry
Metal
Non-Combustible
Frame - exterior walls constructed of wood or other combustible materials such as brick veneer, stone veneer, wood and stucco on wood. Joisted Masonry - exterior walls constructed of masonry materials such as brick, concrete, block, stone or similar materials and the floors and roof are of wood construction. Non-Combustible - exterior walls, floors and roof constructed of metal, gypsum or other non-combustible materials.
Location Address (property to insure)
Location Address
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Line 1
Line 2
City
State
Zip Code
Country
County
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Chose one that applies
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I'm the Owner
I'm the Contractor
I'm Both the Owner & Contractor
Type Project
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Residential Property
Commercial Property
Builders Name
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If Builder is different than the owner, list builders name here.
Choose all that apply
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Builder has 2+ Year Experience
Builder has not had a single loss greater than $10,000 in 3 years
Builder has built > 3 homes last year
Builder is building >3 homes this year
How many months of coverage needed
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Select one
1 month
2 months
3 months
4 months
5 months
6 months
7 months
8 months
9 months
10 months
11 months
12 months
If for loan, what is your closing date?
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If not applicable, enter NA
Lenders mortgagee clause & address?
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Put your lender or banks mortgagee info here. If you don't have it yet put NA
Additional Notes
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