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 ProductionInsurance.com
  A Service of Supple-Merrill & Driscoll, Inc.

 

  

 

 Builder's Risk Application Instructions

  1. Please complete and submit this online application for a free, no-obligation quote.

  2. Please be sure to provide all required information in order to receive a quotation. 

 

 Program Information

This is a secure application.  Strong cryptography is implemented via the Secure Sockets Layer protocol.  Our Privacy Policy.

  PDF Application (Fillable)

   

( indicates required information)

Applicant Information

Name of Company / Organization:
Entity:

Full Name of Contact:
Number:
Fax:
Street Address:
City, State: ,  
Zip/Postal Code:

Email:

We will never rent, sell, or share your email address.

Website:
Applicant Type:

Risk Details
Operations:

Description of Business/Operations:

Insurance History
Any insurance declined or cancelled in the past 3 years?

Yes  No

Any loss in the past 3 years?

Yes  No

Any prior insurance coverage?

Yes  No

Project Qualification
Project Type:
Project Scope:

Construction Type:

Click Here for Construction Type Definitions

Construction Project Value:

The construction project value represents the total amount spent on the project.  This does not include the insurable value of any existing buildings.

Existing Building Value:

The existing building value represents the insurable value of structures already in existence that are part of the project.  Generally, existing building coverage is required for renovations or additions.

Year Built:

Required for existing building coverage.

Project Zip Code:

Project Location and Duration
Project Name:
Project Description:
Start Date:
Project Duration:
Street Address:
City, State: ,  
Zip/Postal Code:
Additional Location Information
Occupancy:
Usage:
Ownership:
Square Feet:
Number of Floors:
Basement:
Distance From Fire Department:
Distance From Fire Hydrant:
Protection Class:
Closest Body of Water:
Flood Zone:
Security Questions
1. Any Fire/Burglar Devices?

Yes  No

2. Type of Alarm

3. Smoke detection included?

Yes  No

4. Any motion detectors?

Yes  No

5. All doors and windows have contacts?

Yes  No

6. Any watchmen or guards during non-working hours?

Yes  No

7. Property completely fenced?

Yes  No

8. All entrances/exits covered/gated?

Yes  No

General Contractor

Please provide the name, contact information and experience for the general contractor.
Name:
Street Address:
City, State: ,  
Zip/Postal Code:
Number:

Email:

We will never rent, sell, or share email addresses.

Years Experience:

Architect

Architect's Name:

Financial Institution / Lender

Name:
Street Address:
City, State: ,  
Zip/Postal Code:

Additional Interest Requirements:

Loan Number:

Coverage Term

Policy Effective and Expiration Dates:

From: To:

Up to 2 Years

Inland Marine

Policy Deductible:

Earnings, Rents, and Soft Costs:

Soft costs are expenses relating to covered property consisting of: advertising and promotional expenses; architectural and engineering supervisory services and consulting fees; audit and bookkeeping services; commissions or fees for the renegotiation of leases; fees for licenses and permits; insurance premiums for builder's risk, workers' insurance and general liability insurance; interest on the construction loan; realty taxes and other assessments; rental or lease expense of construction equipment.

Property While at other Locations:
Property in Transit:
Construction Trailers & Contents:
Trees, Shrubs, and Plants:
Ordinance or Law:

Earthquake:

Earthquake coverage is only available for frame projects.

Flood: Excluded
Wind: Included
Terrorism: Included

Notes

 

 

 

Terms and Conditions

Please carefully review the Terms and Conditions below:

  • Please read all exclusions indicated on quotation.

  • The quotation received is not binding on the Insurer in any way.

  • By clicking 'Submit Application' you are not agreeing to purchase coverage.  Via email, you will receive a free, no-obligation insurance quotation.

  • Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and (NY: substantial) civil penalties. (Not applicable in CO, HI, NE, OH, OK, OR, VT). In DC, LA, ME, TN and VA, insurance benefits may also be denied.
  • Please note that once coverage is bound, the policy cannot be cancelled.

  • The insurance quotation will be based solely on the coverages and limits selected on this application.

  • Please ask your Supple-Merrill & Driscoll, Inc. representative to explain coverage details, exclusions, limits or other provisions of any insurance policy.

Type your name below, to indicate that you have read

and accepted the Terms and Conditions above:

 

 

 

  

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