Builders Risk Quote Form

Builders Risk Insurance Quote Form

Builders Risk Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!

Personal Information

Your Name:

Street Address:

Suite or Building Number

City:

State:

Zip Code:

E-Mail (REQUIRED):

E-Mail again for accuracy:

Phone:

000-000-0000

Fax (optional):

000-000-0000

Entity Type

Project Information

Project Name

Project Address

Project City

Project County

Project State

Zip

Type of Project

Construction Material

Modular Construction?

Policy Deductible

Building total square footage

sq. ft.

Fire Protection Class ?

(If unsure, Answer Fire Department questions below )

Is property within 5 miles of a fire department?

Is property within 1,000 feet of a fire hydrant?

Please describe premises security

Brief description of project

Mortgagee or Loss Payee

What is the start date of the project?

Start
End

What is the insured construction amount?

Contractor Information

General Contractor Name & Address
(If Different from Named Insured)

Does builder have at least 2 years experience

Type of Contractor

Number of units constructed last 12 months

Please Complete this section only if quote is for remodeling project

Is coverage for existing structure desired?

What is value of existing structure?

What is value of remodel improvements?

Is Project Profit Included?

Will dwelling be occupied during construction?

Will construction begin within 60 days of effective date?

Age of dwelling

Years

When was heating system last updated?

When was electrical system last updated?

Any foundation, structural changes or movement of
load bearing walls?

Please describe details of remodeling changes

Notes, Comments or Special Instructions

Any prior event with any losses of any kind declared by the insured and/or known by the broker?

How did you hear about us?

Send my quotation via:

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We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales or marketing By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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