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Builders Risk - Course of
Construction |
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Allen
Financial Insurance Group
Call
Toll Free 1-800-874-9191 Fax
480-452-0593
www.EQGroup.com |
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For no-obligation
Builders Risk insurance quote, please complete
the following form
For an immediate
telephone quote call 800.874.9191
Builders
Risk Policy description
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| Insured Name |
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| Address
1 |
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| Address 2 |
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| City |
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| State |
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| Zip |
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| E-mail |
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| Phone |
-
(Area Code + Number) |
| Fax |
-
(Area Code + Number) |
| Entity Type |
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Broker Information
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| Broker Name |
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| Broker E-mail |
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Project Information
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| Project Name |
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| Project Address
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| Project City |
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| Project County |
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| Project State |
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| Zip |
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Type of Project |
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Construction Material |
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Modular Construction? |
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Policy Deductible |
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Building total square
footage |
sq. ft. |
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Fire Protection Class ? |
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| Please
describe premises security |
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| Brief description of
project |
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Mortgagee or Loss Payee |
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| What is the
start date of the project? |
| Start |
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| End |
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| What is the
insured construction amount? |
$
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Contractor Information
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General
Contractor Name & Address
(If Different from Named Insured) |
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| Does
builder have at least 2 years experience |
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| Type of
Contractor |
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| Number
of units constructed last 12 months |
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Please complete this section if a Remodeling Project
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Is coverage for existing
structure desired? |
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What is value of
existing structure? |
$
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What is value of remodel
improvements? |
$
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Is Project Profit Included? |
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Will dwelling be occupied
during construction? |
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Will construction within 60
days of effective date? |
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Age of dwelling |
Years |
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When was heating system last
updated? |
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When was electrical system
last updated? |
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Any foundation, structural
changes or movement of
load bearing walls? |
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Please describe
details of remodeling changes |
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Notes, Comments or Special
Instructions |
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Underwriting Questions |
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Claim History |
| Any prior event with any losses of
any kind declared by the insured and/or known by the
broker? |
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How did you hear about us? |
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Insurance Definitions |
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