Renovation / Construction Insurance Request Form
Less emails, more efficiency! Please complete the form below to obtain insurance coverage for a renovation or construction project. Once this is complete, we'll shop our markets for accurate coverage & best cost. Thank you, Nick Ramirez CA Lic # 0K79987.
What date would you like coverage to begin?
What is the name/entity name to be insured?
The applicant is a(n):
Mailing address for the policy?
Who is Signing DocuSign?
Please enter a valid phone number.
Date of Birth
Street Address Line 2
State / Province
Postal / Zip Code
What is the labor budget (aka soft cost) for this project?
What is the materials budget (aka hard cost) for this project?
How long will this project be active?
6 Months or Less
Longer than 1 Year
Will there be any work done on the foundation of the property?
What best describes the work to be done on this project?
Remodel - Remodeling of interior finishes; exterior painting; replacement of interior fixtures, cabinets, flooring, etc. No structural changes. *Premium is Pro-Rata*
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. *Premium is Fully Earned, No Refunds*
Restructuring - Repair, replace, remove load bearing walls. Adding additional stories, adding stairways or elevators. Structural retrofitting or foundation work such as underpinning and/or dewatering. (if this is your selection, please upload project plans below) *Premium is Fully Earned, No Refunds*
Upload docs like Scope of Work, Appraisal, GC Information, Insurance Requirements, Pans/Designs, etc.
Drag and drop files here
Choose a file
Payment & Notes
How will this policy likely be paid?
Directly to the entity or individual with bank account or credit card
Closing cost with escrow
Any special notes you'd like to add?
Should be Empty: