Builder's Risk Form
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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đź“Ť Property & Project Details
Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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
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
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đź’µ 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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đź‘· Builder & Ownership Info
Is the applicant the
*
builder
property owner
General Contractor’s Name and Contact
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.
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
Submit
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