Builder's Risk Insurance
Business Name
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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📍 Property & Project Details
Property Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
County
What is the condition of the existing structure
*
Poor
Fair
Good
Date Purchased
*
-
Month
-
Day
Year
Date
Type of Project
*
New Construction
Renovation
Coverage For Existing Structure
*
Include
Exclude
Is this Project
*
One-Shot (One Project)
Reporting Form (Multiple Projects)
Will the property be occupied during construction?
*
Yes
No
Policy period requested
*
6 Months from effective date
9 Months from effective date
12 Months from effective date
Estimated Completion Date
*
-
Month
-
Day
Year
Date
Property Type
*
Please Select
Residential 1–4 family
Commercial
Multi-Family
Mixed Use
Is the property currently under construction?
*
Yes
No
If Yes, date started
-
Month
-
Day
Year
Date
Any construction already started? If yes, percent % completed
*
Percent needs to be under 30% for approval.
Fire Hydrant located under 100 feet?
*
Yes
No
Is this ground-up construction? (starting with just land)
*
Yes
No
Description of work to be performed
*
Will this project involve installation of solar?
*
Yes
No
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🧱 Construction Info
Construction Type
*
Please Select
Frame
Joisted Masonry
Non-Combustible
Fire Resistive
Square Footage
*
Number of Stories
*
Please Select
1
2
3
4
Basement?
*
Yes
No
Sprinklered?
*
Yes
No
Year Built if renovation
To expedite the process, you can send over all pictures of all four sides of the building you want to insure.
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💵 Financial Details
Dwelling/Structure Value
*
Total Project Cost
*
Soft Costs to Cover?
*
Architectural, permits, finance charges, etc.
Deductible Preference
*
Please Select
$1,000
$2,500
$5,000
$10,000
$25,000
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👷 Builder & Ownership Info
Is the applicant the
*
builder
property owner
General Contractor’s Name and Contact
If you have a contractor, we will need this info.
Is this project being subcontracted out?
*
Yes
No
Is a construction contract in place?
*
Yes
No
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👤 Insured Information
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How would you like us to contact you?
*
Please Select
Call
Text
Email
How did you hear about us?
*
Please Select
Google
Google Maps
ChatGpt
Referral
Ines Belman
Jackie Wyne
John Shawareb
TEXT (405) 369-4641 (We can send an Opt-in text) From OKC Insurance Brokers
*
Yes
No
When do you want your policy to start?
*
-
Month
-
Day
Year
Date
Notes
You can also add the mortgagee clause and loan number here.
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