Application Information Applicant
General Contractor
Owner
Developer
Name of Applicant/Named Insured: Mailing Address:
Project Name: Project Term:
Start Date
End Date
Producing Branch/Office: Producer/Broker Name and Phone Number: Mailing Address:
Does your agency currently control this business: If this is a General Contractor or Developer provide current insurer information: Project Information (Attach engineering or architectural documents if available.) Project Description:
Project Address: General Contractor: GC Years of Experience: Architect Name: Number of Buildings:
GC Website:
# Stories/Building:
Square Footage:
# Stories Below Grade:
# of Units (Residential):
Foundation Type:
Safeguards
Construction Type
Build and Occupancy
Frame
New Construction
Fenced and/or Lighted
Joisted Masonry
*Renovation
Watchman Sprinklered Public F.D.
Steel
Addition
Masonry non-combustible
Commercial Residential
Fire Resistive
Volunteer F.D.
Other * If renovation, attach details of renovation work and notify if existing structure coverage is needed Policy Limits (Please include Construction Budget.) Hard Costs $ Loss of Rents $ Soft Costs $ Business Income $ Existing Structure Construction Loan Interest $ (Replacement Cost) $
# of Months
Earthquake
$
Flood $
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