Insured name

*

Insured street address

*

Insured city

*

State: -Select- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip: -

                  Email address

Phone number

Fax number

Type of construction

*

-Select- Residential (1-12 Single Family Dwellings) Commercial

Policy period

*

to
One Year from Effective Date
(12:01 a.m. Standard Time at your mailing address above.)

Has the project started?

*

Yes No

Percent complete %

Value of all covered property at all locations

*

$ Numeric

Property state

*

-Select- CA California Only

Property street location

*

Property city

*

State: CA Zip: -

Property county *

-Select- ALAMEDA ALPINE AMADOR BUTTE CALAVERAS COLUSA CONTRA COSTA DEL NORTE EL DORADO FRESNO GLENN HUMBOLDT IMPERIAL INYO KERN KINGS LAKE LASSEN LOS ANGELES MADERA MARIN MARIPOSA MENDOCINO MERCED MODOC MONO MONTEREY NAPA NEVADA ORANGE PLACER PLUMAS RIVERSIDE SACRAMENTO SAN BENITO SAN BERNARDINO SAN DIEGO SAN FRANCISCO SAN JOAQUIN SAN LUIS OBISPO SAN MATEO SANTA BARBARA SANTA CLARA SANTA CRUZ SHASTA SIERRA SISKIYOU SOLANO SONOMA STANISLAUS SUTTER TEHAMA TRINITY TULARE TUOLUMNE VENTURA YOLO YUBA

Type of policy * 

-Select- One-Shot Remodeling Construction One-Shot New Construction

Construction material

*

-Select- Frame Joisted Masonry Non-Combustible Masonry Non-Combustible & Fire Resistive

Do you have any additional insureds?

*

Yes No

Is the builder's name different than the named insured?

*

Yes No

If yes, please enter Builder's Name:

Deductible

*

$ 500 1000 2500 5000 Other
If other, please enter amount: Numeric

Is the structure modular?

*

Yes No

Is the location apartments, condominiums or multi-unit structure(s)?

*

Yes No

Estimated length of project

*

Months Years

Form of Business

*

Individual Partnership Corporation Joint Venture Other

Structure

*

1-12 Family Dwelling Commercial Structure

Any one structure

*

$ (numeric only)

Property temporarily at any other premises

$ 10,000

Property in transit

$ 25,000

All covered property at all locations

*

$ 500,000(numeric only)

Any coverage for development / subdivision fences, walls or signs

*

Yes No
If Yes, please enter coverage amount:
$ (numeric only)

Does builder/remodeler have at least 2 years experience?

*

Yes No
 

Business description

*

Homebuilder Commercial General Contractor
Remodeler*

*If remodeler, any foundation, structural changes or movement of load bearing walls?
Yes No

Number of structures built/remodeled during the past 12 months?

*

1-2 3-50 Other
If other, indicate number

Number of structures projected for the next 12 months?

*

1-2 3-50 Other
If other, indicate number

Loss experience for last 3 years? Indicate cause of loss for any claim over $5,000

*

None