R.R.I.S. BUILDERS RISK (COC) QUOTE REQUEST    

Please provide the following contact information:   

 (The Referral Agent is the name of your Insurance Agent in our office or how you became aware of our website)

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

FEIN#

What type of entity are you?

Individual Partnership Corporation Joint Venture Other

What is the address of the project, including county?

Project type:

Residential Residential over $3 million Commercial under $3 million Commercial over $3 million

What type of construction is this?

New Construction Remodel

If this is a remodel, what year was it built?

Who is th Project Manager?

Owner/Builder Remodeler Commercial General Contractor

What is the name of the General Contractor/Remodeler?

First Name
Last Name

How many years has this Contractor/Remodeler been in business?

Has this Contractor/Remodeler had any losses?

yes
no

How many structures has this Contractor/Remodeler built in past 12 months/next 12 months?

What is the projected start date?

What is the anticipated completion date?

If project has already started, what percentage of the project is finished and what date did it start?

What is the completed value of the building (sales price less cost of land)?

What are the soft costs (overhead, profit, interest, fees, accounting, etc)?

What are the values of fences/walls?

What deductible would you like?

How many buildings are there?

How many units are there in each building?

How far apart are the buildings?

What fire protection class is the project in (range is 3 to 10, depending on fire department response time and availability of water)?

What construction type is the building?

wood frame joisted masonry masonry non-combustible fire resistive

What is the name and address of additonal insured/mortgagee and loan number?

Please add any comments or additional information, if any: