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Builders Risk and Vacant property Quote Form

* Indicates required field

Contact Information

Company Name *

If you want the policy listed in a company name, enter the name here.

Contact Name *

First

Last

Email Address *

Company Type *

Individual Corporation LLC Other

How did you find us? *

If other company type, explain *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

How many months of coverage needed *

Year Built *

If new ground up enter current year, otherwise enter year the existing structure was built.

Start Date *

Provide the project start date here

# Stories *

Expected Completion Date *

Square Feet *

Construction Type *

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.

Builders Name *

If the builder is other that you, list the builders name. If you are the builder enter "NA"

Builders Address *

If builder is other than you, list their street, city, state and zip

Notes (list mortgage co., bank etc. see instructions *

If you want the builder or property owner or bank listed on the policy provide their name, address and email in the note field along with any other information you want to provide.

Location Address (property to insure)

Location Address *

Line 1

Line 2

City

State

Zip Code

Country

County *

If Remodeling, do you want coverage for existing structure? *

Yes No

Choose all that apply *

Property within 1,000 feet of tidal water Property is on a barrier island Property is Modular Property in wind pool area

Chose one that applies *

I'm the Owner I'm the Contractor I'm Both the Owner & Contractor

Builders Name *

If Builder is different than the owner, list builders name here.

Choose all that apply *

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

Choose all that apply *

New Ground Up Construction Remodeling - Non Struructural Remodel - Minor Structural Remodel - Major Structural

Remodel - Remodeling of interior finishes; exterior painting; replacement of interior fixtures, cabinets, flooring, etc. No structural changes. Remodel/Minor Structural - Remodel work as listed above and minor changes to exterior (doors, windows, skylights, etc.). Roof replacement, ground floor additions and all non-structural changes such as HVAC, plumbing and electrical. Restructuring - Repair, replace, remove load bearing walls. Adding additional stories, adding stairways or elevators. Foundation work such as underpinning and/or dewatering.

Type Project *

Residential Property Commercial Property

Amount of Rennovation *

List the total dollar amount of the rennovations to be done.

Value of Existing Structure *

Insert the value of the existing structure, if you want coverage for existing structure.

Total Amount of Coverage *

List the total amount of coverage requested.

Choose All work being done which applies. *

Adding New Roof Replacing Load Bearing Walls Adding Horizontal Addition Adding Vertical Addition Under Pinning Work Updating Electrical Updating Plubming Updating HVAC

Choose All that apply *

Current Roof < 15 Years Old Current Electrical < 15 Years Old Plumbing < 15 Years Old HVAC < 15 Years Old

If Renovation describe work being done? *

Submit

Builders Risk and Vacant property Quote Form

Contact Information

Location Address (property to insure)

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