Builder’s Risk Insurance Application
1. Applicant Information
Applicant/Company Name
Contact Person
Phone Number
Email
Mailing Address
2. Construction Site Information
Site Address
Type of Project
Type of Structure
Number of Stories
Square Footage
Construction Type
Intended Occupancy
3. Project Information
Project Start Date
Estimated Completion Date
Project Duration (months)
Total Value of Project
Value of Existing Structure
Value of Renovation
Project Description / Scope of Work
4. Contractor Information
General Contractor Name
Licensed?
Yes
No
License Number
Insured?
Yes
No
Insurance Company
Limits of Liability
5. Additional Information
Any prior Builder's Risk losses?
Yes
No
Protective Measures
Fire Protection (hydrants, sprinklers, alarms)
Additional Information / Remarks