Project Specific Insurance Quote Request Project Specific Insurance Quote Request Step 1 of 7 14% Name(Required) First Last What is your position and role in this project?(Required)Your entity is(Required)CorporationDBAIndividual - Sole ProprietorJoint VentureLLCNot-For Profit OrganizationPartnershipSub Chapter "S" CorpFull Legal Business Name(Required)Does your company use any DBA or Trade Names(Required) Yes No What DBA or Trade Name(s) do you use?(Required)Email(Required) Phone Number(Required)Alt Phone Number (cell, home)Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Website Date Business Started(Required) MM slash DD slash YYYY Project Name(Required)Property Address of the Project(Required)If the location address differs from your mailing address, enter the location address below. Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Please provide a detailed description of the project(Required)Project Start Date(Required) MM slash DD slash YYYY Projected Completion Date(Required) MM slash DD slash YYYY What is the source of the financing?(Required)Is the seller of the building(s) to be covered?(Required) Yes No N/A Sellers are to be covered as...(Required) Named Insured Additional Insured Coverage being requested(Required) Wrap Non-Wrap Audit ContactName(Required) First Last Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) Is the Loss Control Contact the same as the Audit contact?(Required) Yes No Is the Loss Control Contact the same as the Administrative contact?(Required) Yes No Loss Control ContactName(Required) First Last Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) Administrative ContactName(Required) First Last Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) Project DetailsAny construction to involve use of EIFS (Exterior Insulation Finish System)?(Required) Y N Pex or Kitec piping to be used?(Required) Y N Has any work started at the project site?(Required) Y N Please provide details(Required)What work has been started, when did it start, how much of the project has been completed?Is it all new ground up construction?(Required) Y N What types of units are being built?(Required) Single Family Dwellings Townhouses Condos Commercial Other Please describe "other"Single Family Dwellings# of Units# of Buildings# of StoriesConstruction TypeWood FrameJoisted MasonrySolid MasonryMetal & GlassTownhouses# of Units# of Buildings# of StoriesConstruction TypeWood FrameJoisted MasonrySolid MasonryMetal & GlassCondominiums# of Units# of Buildings# of StoriesConstruction TypeWood FrameJoisted MasonrySolid MasonryMetal & GlassCommercialTTL Area in Sq Ft# of Buildings# of StoriesConstruction TypeWood FrameJoisted MasonrySolid MasonryMetal & GlassOther# of Units# of Buildings# of StoriesConstruction TypeWood FrameJoisted MasonrySolid MasonryMetal & GlassFor the following: Construction Cost definition: The total cost of all work let or sublet in connection with each specific project including: the cost of all labor, materials, services and equipment furnished, used or delivered for use in the execution of the work; and all bonuses and commissions. Do not include the cost of the land, financing (including lender’s fees), insurance charges, and permit fees.Estimated Direct Total Field Laborer Payroll (for ALL contractors) for project term(Required)Excluding sub-contractor and supervisory costs.Estimated total Construction Cost for project term:(Required)Describe surrounding exposures including proximity of any adjacent structures:NorthSouthEastWestAre there any exposure to hillsides, slopes, landfill or other potential subsidence areas?(Required) Y N Explain(Required)Was the site previously developed?(Required) Y N Explain(Required)Will the project involve any demolition of existing structures?(Required) Y N Explain(Required)Is the Wrap-Up coverage to apply for demolition operations?(Required) Y N PROJECT TEAM – BACKGROUND/EXPERIENCEProject ArchitectName(Required) First Last Phone(Required)Email(Required) Describe Architect’s past Residential experience:(Required)Project General ContractorName(Required) First Last Phone(Required)Email(Required) Describe past Residential construction experience of the General Contractor (such as the number and types of residential structures built):(Required)Years in business(Required)Years building residential structures(Required)Has the GC had any losses in the last 7 years? Y N GC LossesPlease add policy years starting with the most recent. Note: Incurred Losses = Expense + Paid + ReservedPolicy periodInsurerValuation Date# of Claims$ Losses Incurred Add RemoveHas the insured had any Construction Defect Losses? Y N Construction Defect Losses(Required)Please add policy years starting with the most recent. Policy periodDate of Loss$ Losses IncurredOpen/ClosedDescription OpenClosed Add Remove Risk ManagementPre-Construction OperationsAre there any known pollution exposures on jobsite?(Required) Y N If yes, describe known pollution exposures on jobsite(Required)Were there any significant design or material selection decisions made to prevent claims?(Required) Y N If yes, please provide specific details of such decisions?(Required)Does the General Contractor have a formal subcontractor pre-qualification program?(Required) Y N If yes, please provide specific details of their program?(Required)Please describe how you plan to address construction defect complaints from the buyers of your units throughout the state statute of repose:(Required)Quality Control ProgramDoes the Named Insured have a Quality Control Program in effect to monitor all construction activities?(Required) Y N Who is responsible for managing the program?Briefly describe the program and/or attach a copy of the program to this questionnaireDoes the Named Insured have a written Site Inspection Program?(Required) Y N Are surprise inspections conducted? Y N When are the inspections performed(Required)Who determines the inspection schedule?(Required)Who conducts the inspections?(Required)Briefly describe the established criteria for required follow-up.(Required)Does the Named Insured have any Independent Inspections/Assessments performed?(Required) Y N Who is providing this service?(Required)What percentage of units/project are to be inspected and how often?(Required)Briefly describe the scope of their services and/or attach a copy of their contract to this questionnaire:(Required)Safety ProgramDoes the Named Insured have written safety program?(Required) Y N Who is designated as the safety manager on site?(Required)Is this person on site full-time?(Required) Y N Does the program require that there be scaffolding and fall protection?(Required) Y N What height requirement is maintained?(Required)Which does the safety program specifically address?(Required)SecurityNuisancesPower LinesTraffic ControlUtility IdentificationSELECTYesNoNot ApplicableSELECTYesNoNot ApplicableSELECTYesNoNot ApplicableSELECTYesNoNot ApplicableSELECTYesNoNot ApplicableAre customers and future customers or other third parties allowed on site?(Required) Y N What precautions are taken to protect third party visitors(Required) Document UploadsIn order to serve you me quickly, please upload copies of the documents requested below.Geotech ReportAccepted file types: pdf, doc, docx, Max. file size: 6 GB.Architectural RenderingAccepted file types: pdf, doc, docx, Max. file size: 6 GB.Project SitemapAccepted file types: pdf, doc, docx, Max. file size: 6 GB.BudgetAccepted file types: pdf, doc, docx, Max. file size: 6 GB.Project TimelineAccepted file types: pdf, doc, docx, Max. file size: 6 GB.GC's 5 Year Currently Values Loss RunsAccepted file types: pdf, doc, docx, Max. file size: 6 GB.Certificate of Professional Liability for the ArchitectAccepted file types: pdf, doc, docx, Max. file size: 6 GB.PhoneThis field is for validation purposes and should be left unchanged.
