Builder's Risk Questionnaire

Builders Risk Questionnaire
Please enter the Names (Please, enter the Owner's Name and the Contractor's name Below)
Owner's name*
Contractor's Name*
Email*
example@example.com
Phone Number*

Area CodePhone Number
OwnerContractorOwner/ContractorOther
2. Insurance Policy Mailing Address*
3. Policyholder FEIN
4. Project start date*

MonthDayYear
5. Construction Project Physical Location*
6. Estimated length of project? (Please factor in customary job delays)*
7. Description of Project and work to be completed. *
New ConstructionRemodeling/RenovationOther
YesNo
10. What is the total job contract value?*
11. Change Order percentage (Example 20% or 30% additional cost to job contract value to account for change orders)*
YesNo
12-1. If so, what is the value of materials or equipment being stored at temporary location?
YesNo
13-1. If so, what is the maximum value?
14. Number of structures projected for the next 12 months?*
15. Any Builders Risk losses over $10,000 in last 3 years? (if yes please describe loss)*
FrameJoisted MasonryNon-CombustibleMasonry Non- CombustibleFire ResistiveOther
17. Number of Stories?*
18. Intended occupancy (Example: Residential, Office, Restaurant, Warehouse, etc.)*
YesNo
20. Existing Structure Square Footage:*
20-1. New Structure Square Footage:
YesNo
22. * Soft Costs Limit
* Soft Cost Expense Types: Advertising & promotional, Interest on const loan, Architect, Engineer & Consultant Fees, Real Estate & Property Tax Assessment, Commissions or fees for the renegotioation of leases, Insurance premiums, Legal & Accounting fees, Fees for License & Permits.
23. Equipment Breakdown Coverage
24. Testing Coverage
25. Loss of Rents Limit
26. Loss of Revenue Limit
27. Flood Coverage Limit
28. Water Backup Coverage
29. Earthquake Coverage Limit
30. Green Construction Endorsement
31. Any model home exposure?
To better assist with the Builders Risk Proposal, please upload any Construction Plans, Site Drawing, Engineering Plans, etc

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By ticking this box you acknowledge that all of the information entered in the questionnaire are accurate and revised. You also agree to be contact by email or text.
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Builders Risk Questionnaire

Please enter the Names (Please, enter the Owner's Name and the Contractor's name Below)