Builders Risk Insurance Application Submission of this information does not represent a binding of any insurance contract or agreement. Additional information may be required in order to get an accurate quote of insurance. Applicant InformationName of Applicant First Last Date of Birth MM slash DD slash YYYY Add Applicant? Yes No Name of Applicant First Last Date MM slash DD slash YYYY Previous Insurance & Loss HistoryHave you experienced any losses related to construction projects in the past? (this incldues losses whether an insurance claim was made or not.) Yes No Have there been any incidents or losses at this property within the past 5 years? (this includes events where a claim may not have been filed.) Yes No Has any insurance company ever refused, cancelled or declined to renew your insurance? Yes No Project LocationAddress Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Is the property located in a known flood zone? Yes No Has this property ever been evacuated or issued an evacuation order due to flooding? Yes No Is the property currently located in an area under an active flood warning? Yes No Distance from the construction site to the nearest body of water (river, lake, pond..etc.) Distance in Feet:Is the property located within 25 km of an active wildfire? Yes No Project DetailsEstimated Project Duration. Number of Months Required for CompletionType of construction work being performed. New construction (Building a Completely New Structure) Renovation of an Existing Structure Addition Plus Renovation to an Existing Structure Combination of Renovation and New Construction Is Covearage Required for the Existing Structure? Yes No Year Existing Structure BuiltType of Structure Involved in this Project Single-Family Home (Detached or Semi-Detached) Laneway House/ Guest House / Carriage House / ADU Garage, cabin, or shed Duplex Triplex Fourplex Five-plex Seven-plex Eight-plex Individual condo or apartment unit Boat shed or dock (on pilings) Boat shed or dock (floating installation) What Will the Property Be Used for Once Construction is Completed Owner occupied Rental property Already sold to a buyer Spec build (not yet sold) Primary Construction Type Wood frame Concrete block / masonry Structural Insulated Panels (SIP) Log construction Fire resistive construction Clay construction Straw bale construction Modular or prefabricated construction Insulated Concrete Form (ICF) How Many Separate Structures Are Being Built On This Site – Number of Structures:Total finished square footage of the completed structure(s) Including BasementIs the Property Larger than 15 Acres? Yes No Will a Professional General Contractor or Project Manager Oversee the Construction? Yes No Please Explain Who is Managing The ProjectHomeowner – has built entire homes in the pastHomeowner – has taken a home building courseHomeowner – is / was in the construction businessHomeowner – no prior construction experienceHomeowner – with a relative with construction experiencePrivate Indvidual – has built entire homes in the pastPrivate Individual – is / was in the construction businessPrivate Individual – no prior construction experienceName of the General Contractor or Professional Project ManagerWhat is their experience? No prior experience Have built several projects of same size / scope Last 3 Largest Projects of General Contractor / Project ManagerYear CompletedType of ProjectValue ($)Year CompletedType of ProjectValue ($)Year CompletedType of ProjectValue ($)Has Construction Already Started? Yes No When Did Construction Activity Start? MM slash DD slash YYYY Have there been any incidents on the project site that could give rise to a claim or increase in exposure on the site? Yes No What dollar ($) Amount of the Construction Budget Has Been Spent as of Today?What Stage of Construction is The Project at?Foundation work being conductedFramed, no doors and windowsFramed, doors and windowsLock-up, finishng work to be doneComplete, waiting for occupancy permitOtherSpecify – OtherIs the Applicant deliqnquent in paying any of the trades, or is there any dispute with respects to this project? Yes No Has the owner or contractor experienced any recent financial distress such as bankruptcy or insolvency? Yes No Did the Applicant take over this project from a previous owner that was under financial duress? Yes No Will there be a monitored alarm at lockup? Yes No Will the Construction site be fully fenced? Yes No Coverages Required:Hard Costs ($)The total value of physical construction costs associated with the project, including labour, materials, supplies, and property that will become part of the completed building. This includes all work in progress at the project site that is owned by the insured or included in the insured project value.Existing Structure Coverage ($)Existing Structure (“Functional Value” – Valued at the Usability Going into the Final Completed Project.)Soft Costs ($)Loan interest and other carrying costs during construction (taxes, utilities, insurance, permits, etc.).Deductible$2,500$5,000$10,000$25,000$50,000$100,000Deductible for Property CoveragePremises Liability Limit$2 Million$5 MillionCovers liability arising from ownership of the property during construction. IMPORTANT: This does NOT cover any construction activities. All construction work must be insured separately by the contractors or general contractor through their own liability insurance.Is Delayed Project Completion Coverage Extension Required? Yes No This coverage protects against loss of rental income or earnings if a covered loss delays completion of the project. Coverage applies only to delays caused by insured damage and is typically subject to a waiting period (e.g. 30 days) and monthly limits.Maximum Payable Any One Month ($):Maximum Payable Any One Loss ($)Consent(Required) I agree to the Privacy Policy and acknowledge the Disclosure Statement.
