Renovation / Construction Insurance Request Form

Renovation / Construction Insurance Request Form

Less emails, more efficiency! Please complete the form to obtain coverage for renovation and construction projects. Once this form is complete, we get to work shopping our carriers for appropriate, best option coverages. The Musico Agency, LLC dba Goosehead Insurance - The Musico Agency. Multi-State Licensed
Please note, coverage will not be bound, changed, or confirmed through text, voicemail. this form, or email. An agent will contact you to finalize quotes.
THE MORE INFO YOU PROVIDE, THE BETTER PREPARED WE ARE TO HELP!

* Are required fields
What date would you like coverage to begin?

MonthDayYear
Date
What is the individual's name or entity's name to be insured?*
(please use legal name)
The applicant is a(n):*

IndividualLLCINCOther
Full MAILING address for the policy*
APN/Parcel Number
(If street address has not been assigned, APN is required)
This property is located in (State) . And the county this property is located is (County) .
Name of person who will be signing DocuSign?*

First NameLast Name
Email*
For person signing docuSign forms. example@example.com - must be valid email address
Cell Phone Number*
Please enter a valid cell phone number.
Date of Birth*

MonthDayYear
Date
Project Site and Information
Project Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the labor budget, including soft costs for this project?*
What is the material budget (aka hard costs) for this project?*
What is the expected duration of the project?*

Less than 6 months6-9 months1 YearMore than 1 year
Will there be any work on the foundation of the property?*

YesNo
Please choose what best describes the work that is being done on this project:*

Remodel - remodeling the interior finishes; exterior painting; cosmetic finishes; replacement of interior fixtures, cabinets, flooring, trim, etc. No structural changes.Remodel/Minor Structural -includes items above, plus minor changes to exterior such as doors, windows, skylights, etc. Roof replacement, ground floor additions and non-structural changes such as HVAC, plumbing, and electrical.Restructural - 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 you choose this option, please upload project plans.
File Upload - please upload documents such as Scope of Work, Appraisals, GC information, Insurance Requirements, Plans/Designs, HOA requirements, etc.

Cancelof
Payment & Notes
How will this policy likely be paid?*

Directly by the entity or individual with a bank account or credit cardThrough escrow
Please add any other information or notes you would like to share regarding the project and/or your needs.
Should be Empty:

Renovation / Construction Insurance Request Form

THE MORE INFO YOU PROVIDE, THE BETTER PREPARED WE ARE TO HELP!

Project Site and Information

Payment & Notes