Coverage Comparison

Builders Risk Insurance

For California residents only.

After you've completed this form, click on the SUBMIT button to receive your free Builders Risk Insurance. You'll be given an opportunity to specify U.S.Mail, e-mail or fax. Or phone us at 800-211-9584.

Customer Information
Named Insured
E-mail
Mailing address
City
County
State
Zip Code
Home Phone
Work Phone
FAX
Website
Applicant is :	Individual   Partnership   Corporation   Joint Venture
Business Description:	General Contractor  Homebuilder  Remodeler
Contact Person
Contractor's # of yrs experience

Property to be Insured:
Property Address
City
County
State
ZipCode
Completed Value Amount Per Structure	$
Completed Value Amount Per Project Site	$
Name & Address of Additional Insured
Is the Builder's name different that the named insured?	Yes No
If Yes, Builder's name:

Policy Information:
Policy Effective Date (for a 1 year period)
Structure Type	1-12 Family Dwelling    Commercial Structure
New or Remodel	- select - One Shot New Renovation Excluding the existing structure Remodeler Including the existing structure
Construction Material	- select - Frame Joisted Masonry Non-Combustible Masonry Non-Combustible & Fire Resistive
Deductible Options	- select - $1,000 $2,500 $5,000 $10,000
Any one Structure	$
Property Temporarily at any other premises	$
Property in Transit	$
All Covered property at all locations	$
Coverage for Development/Subdivision fences, walls or signs:	$
Protection Town Class	1-8       9       10
Earth Movement?Yes No	Zone:     Limit $
Water/Flood?Yes No	Zone:     Limit $

Underwriting Information:
Yes No	Employee Training?
Yes No	Loss Prevention Program
Yes No	If remodeler, any work involving load bearing walls?
Yes No	Is coverage requested for both the existing structure and the remodeling work?
Yes No	Is this structure located within 1,000 feet of tidal water or located on a barrier island?
Yes No	Is the contractor insuring any other buildings with Zurich within 100 feet of this structure?
1-2  3-5  6-50  Other	Number of structures built during the past 12 months
1-2  3-5  6-50  Other	Number of structures projected for the next 12 months
Yes No	Is there a sales contract on this structure?
Yes No	Secured Sub-division?

More Underwriting Information:
Yes No	Has any interested party ever filed for bankruptcy?
If yes, who & when?
Yes No	Any builders risk / installation losses for the past 3 years?
What was cause of loss for any claim over $5,000
How is this being financed?
Mortgagee  Loss Payee

Apartments, Condominiums, or Multi-unit structures only. (If yes, complete the following questions):
Number of Buildings
Number of units per building
Value per Building
Distance between Building

Have you any special instructions?

Reporting Method
How would you like to receive your Builders Risk Insurance quote?	Phone U.S.Postal E-mail Fax

 

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