Builders Risk
Insured Type - Who is requesting the insurance?
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Owner (owns the property, not doing the work)
Contractor (doing the work, does not own the property)
Owner and Contractor (owns the property and doing the work)
Insured Entity Type
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Individual
LLC
Corporation
Partnership
Other
Insured Name
*
Email
*
example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Insured Mailing Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
When did you purchase the property?
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Builder Name
*
I confirm that the builder/remodeler has at least 2 years of experience.
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Yes
No - not eligible for coverage.
Project Type
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New Construction
Remodeling/Renovation
Do you want to include coverage for the existing structure?
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Yes
No
What is the condition of the existing structure?:
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Poor Condition - Uninhabitable, siding/shingles missing, dilapidated, overgrown landscaping, fire damaged, flooded, vandalized or stripped of copper. Major repairs needed.
Fair Condition - Lacks maintenance and/or minor repairs are needed to bring into average condition.
Good Condition - Well maintained and little/no evidence of deferred maintenance. Minimal repairs can be quickly and affordably resolved and are only cosmetic in nature.
Policy Period
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6 months
9 months
12 months
Has the project started?
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Yes
No
Expected start date
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-
Month
-
Day
Year
Date
Expected completion date of project
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-
Month
-
Day
Year
Date
Description of work to be performed
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Is restructuring involved? For example, removing of walls, adding stories stairways or elevators, foundation work...
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Yes
No
Please explain
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Value of renovations/improvements
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Existing building(s) or structure(s) amount (Coverage will be based on the ACV)
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Total completed value
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Total completed value of all covered property means all costs associated with the building and designing including labor, "overhead" and materials and if included, "profit".
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Referral Partner
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Customer Language
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English
Portuguese
Spanish
Agent Name
Date
-
Month
-
Day
Year
Date
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