Course of Construction Form

Name Insured:
Insured street address:
Contact Number: Email:
Type of Policy:
Type of Construction:
Desired Policy Start date:
Construction material:
Has the Project started? Yes No
If Yes, date started:
Percent completed %
Value of all covered property at all locations:$
Is existing structure coverage desired? Yes No
Do you have any additional insured's? Yes No
Please list:
Is the builder's name different than the named insured? Yes No
If yes, please enter builder's name:
Desired Deductible:$
Is the structure modular? Yes No
Is the location apartments, condominiums or multi-unit structures: Yes No

Estimated length of project:

Form of business: Individual Partnership Corp Joint Venture Other
Any coverage for development/subdivision fences, walls, or signs: Yes No
If yes, Coverage amount:$
Does the builder/remodeler have at least 2 years experience? Yes No
Number of structures built. Remodeled during the past 12 months? 1-2 3-50 Other
Loss experience for last 3 years? None
Indicate cause of loss for any claim over $5,000.
Complete the following questions if remodeling.
If remodeling, age of dwelling?
Is the existing structure considered historical? Yes No N/A
Is the remodeling work on the existing structure to begin within 60 days of the effective date?
Yes No N/A
When was the heating system last updated?
When was the electrical system last updated?
Purchase price of shell?
Amount of renovation/improvements?
Is the Profit included in renovation/improvements amount? Yes No N/A
 
Additional Comments:
IMPORTANT NOTE: This form is provided as a convenience to you. We will make a good faith effort to obtain competitive quotes for your review. Depending on the type of business, we may require more information and will contact you if necessary. Your submission of this form DOES NOT guarantee that any binding offers will be forthcoming from insurers we represent.