What is your first name? *
What is your last name? *
What is your email address? *
What is your phone number? *
Please provide your occupation and employer?
What is your date of birth? *
MM slash DD slash YYYY
What is your primary mailing address? *
Is this the address where the construction/renovation will take place?
Do you have insurance for this property currently?
What is the name of the insurance company?
Are you planning to purchase this property?
What is the closing date?
MM slash DD slash YYYY
General Project Information
Is this a new construction or a renovation project? *
Please select the type(s) of structure(s) you will be constructing. (Select all that apply)
What is the address/lot number where the new construction will take place?
What is the total estimated cost of construction for your new house?
What will the square footage of your new house be?
What type of construction will this new house be?
How many stories will your new house have?
What is the address where the renovation will take place?
Are you planning to purchase this property?
What is the closing date?
MM slash DD slash YYYY
Please describe the other structure(s) you will be constructing.
What is the total estimated cost of construction for the guest house?
What will the square footage of your guest house be?
How many stories will your guest house have?
What type of construction will this guest house be?
What is the total estimated cost of construction for the detached garage?
What will the square footage of the detached garage be?
How many stories will the detached garage have?
What type of construction will this detached garage be?
What is the total estimated cost of construction for the barn?
What will the square footage of the barn be?
How many stories will the barn have?
What type of construction will this barn be?
What is the total estimated cost of construction for the pool?
What is the total estimated cost of construction for the pool house?
What is the total estimated cost of construction for the pool enclosure?
What is the total estimated cost of construction for the other structure(s)?
What is the estimated completed value of the other structures?
Please select the areas that will be included in your renovation. (Select all that apply)
Please describe the other areas that will be part of this renovation.
How much square footage is being added with this addition?
What is the total estimated cost for this renovation project?
What is the estimated completed value of the dwelling?
Will you continue to occupy the residence during the renovation?
What is the address where you will live during the renovation?
Will any of your personal property be stored at this residence during the renovation?
What is the approximate value of the personal property that will be stored at this residence during the renovation?
Will any structure(s) be demolished as part of this project?
Please provide a brief description of the demolition work and the structure(s) being demolished.
Please provide any additional information about the work to be done below.
Construction/Renovation Optional Coverages
Do you want to add coverage for soft costs (I.e. architect's fees, designer's fees, taxes, insurance, etc.)
Please select the coverage limit you would like for soft costs.
Do you want coverage for construction materials in transit/away from the premises?
Please select the coverage limit you would like for materials in transit/away from the premises.
Project Schedule
Has construction already started? *
What percentage of the work is complete? *
What date will this project begin?
MM slash DD slash YYYY
What date will the new construction be fully enclosed?
MM slash DD slash YYYY
What date will this project be completed?
MM slash DD slash YYYY
Interested Parties
Will there be a mortgage for this project?
What is the name of the bank providing the mortgage?
Who is your contact at the bank?
What is the phone number for your contact at the bank?
What is the email address for your contact at the bank?
Will the insurance premium be escrowed?
Is there a mortgage?
Please enter the bank name, if convenient. (Ex. Bank of America NA, ISAOA ATIMA)
Please enter the bank address, if convenient.
Please enter the loan number, if convenient.
Is the insurance premium being escrowed?
Is there a Trust, LLC or Limited Partnership involved in the ownership of this property?
Please enter the name of the Trust, LLC or Limited Partnership:
General Contractor Information
Have you selected a general contractor for this project?
What date will you select your general contractor?
MM slash DD slash YYYY
What is the name of the general contractor's business?
Please enter the site foreman/project manager's name.
Please enter the site foreman/project manager's phone number.
Please enter the site foreman/project manager's email address.
Do you have a certificate of insurance from the general contractor listing you as an additional insured and certificate holder?
Please upload the certificate of insurance for the general contractor so we can review it for coverage adequacy.
Does the general contractor have a builders risk policy in effect for this project?
Will the general contractor be hiring subcontractors?
Do you have a contract with the general contractor?
Please upload a copy of the signed contract.
Does your contract include a waiver of subrogation?
Have you signed a waiver of subrogation with your contractor?
How many years has the general contractor's company been in business?
Please enter a description of the 5 most recent projects the general contractor has completed and their total square footage. (Skip this if the information is not available at this time)
Will you hire subcontractors to do the work?
Risk Management on Site
Has the general contractor provided a written construction plan that defines security and fire protection that will be maintained on this site during each construction phase of the project?
Will an active central station burglar and fire alarm system be in place once the structure is enclosed? *
Please select all risk management strategies that will be employed during the project.
Provide a brief description of the other risk management strategies that will be employed.
Please upload a picture of the fire extinguisher(s) on site, if convenient.
Please upload a picture of the "No Smoking" sign(s) on site, if convenient.
Please upload a picture of the driveway chain, if convenient.
Please upload a copy of an alarm certificate from your alarm company, if convenient.
Documents and Comments
Please use this field to upload any relevant insurance documents. (Ie. Project contract, Contractor's certificate of insurance, etc...)
Please enter any additional remarks in the space below.
How did you hear about us?
Please share who referred you to us.
Can you share what you typed into Google?
Please let us know how you heard about us.
Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.
Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.
