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?
*
-
Month
-
Day
Year
Date
What is the name/entity name to be insured?
*
The applicant is a(n):
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Induvidual
LLC
INC
Other
Mailing address for the policy?
*
Who is Signing DocuSign?
Name
*
First Name
Last Name
Email
example@example.com
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
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Month
-
Day
Year
Date
Project Information
Project Address
*
Street Address
Street Address Line 2
City
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
9 Months
12 Months
18 Months
24 Months
Name of General Contractor Assigned to Project
*
PLEASE DO NOT SKIP THIS INFO - IT'S IMPORTANT WE KNOW WHO IS OVERSEEING CONTRUCTION ON THE JOB
Years of Experience of GC
*
Will there be any work done on the foundation of the property?
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Yes
No
What best describes the work to be done on this project?
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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.
Browse Files
Drag and drop files here
Choose a file
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of
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?
Submit
Should be Empty: