Builder's Risk

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Fields

Producer Information

Producer Name*

Producer Email*

Producer Phone Number*

Agency Name*

Insured Information

Named Insured*

Insured Mailing Address

Project Address

Address Line 1

Address Line 2

City

State

ZIP Code

Insured is

Owner Contractor Developer Other

Name of Contractor

If different from named insured

# of Years in Business

Loss History/3 Years

Does contractor have a risk management or safety division?

Yes No

Does contractor follow "Best Practices" for employee safety?

Yes No

Project Information

Estimated Start Date

Estimated Completion Date

Estimated Term of Project in Days

Currently Under Construction

Yes No

Original Start Date

% Completed

Values Completed

Limits of Liability

New Construction

Existing Structure (if applicable)

Existing Structure options

Replacement Cost Actual Cash Value

Renovation Values

New Addition Value (if applicable)

Values not forming part of project

Furniture, fixtures & equipment

Business personal property

Soft costs

Loss of rents

Loss of earnings

Total project limit

Sublimits

Temporary storage

Transit

Debris Removal

Extra Expense

Extra Expense 2

Extra Expense 3

Optional Coverages (must be checked)

Named Windstorm

Is project location eligible for coverage in a wind pool?

Yes No

Maximum limit available in wind pool?

Earth movement

Earth Movement

EQ Zone

1 2 3 4 5

Flood

FEMA Flood Zone

A B C X V

100 Year Base Flood Elevation?

Elevation of First Finished Floor?

Deductibles

All Other Perils (Catastrophe Peril deductible will be determined by the company)

$5,000 $10,000 $25,000 $50,000 $100,000 Other

If "Other", please specify

More Project Information

Project Description

Project type

Commercial Residential Road Energy

Construction

New Construction Renovation - Nonstructural: Remodel of interior finishes; replacement of interior fixtures, cabinets, flooring, HVAC/plumbing, electrical, etc. Renovation - Structural: Repair/replace/remove load-bearing walls; add additional stories; add stairways or elevators New Addition: Addition of space with remodel/renovation for tie-in purposes only and interior remodel as shown above

Construction of existing building*

Frame Masonry Joist Noncombustible Masonry Noncombustible Fire Resistive

Construction type of project*

Frame Masonry Joist Noncombustible Masonry Noncombustible Fire Resistive

*Construction types:

Frame: Walls are constructed of wood or other combustible materials, including when combined with other materials such as brick veneer, stone veneer, wood ironclad or stucco on wood.
Masonry Joist: Walls are constructed of masonry materials such as clay, adobe, brick, gypsum block, cinder block, hollow concrete block, stone, tile, glass block or other similar material and where the floors and/or roof are combustible.
Noncombustible: Walls/floors/roof are constructed of and supported by metal, asbestos, gypsum or other noncombustible material.
Masonry noncombustible: Walls are constructed of masonry materials of the type described in masonry joist above but with a floor and roof construed of metal or other noncombustible material.
Fire resistive: Walls/floors/roof are constructed of fire resistive materials having a resistance rating of not less than two (2) hours.

Reference to walls means the structural frame and support walls. Reference to floors means the floors and supports. Reference to roof means the roof deck and supports.

Existing Structure Information

Year Built

Current condition of structure

Historic Landmark

Yes No

Date Purchased

Purchase Price

Date(s) remodeled/renovated

Loss Control

Public Protection Class

City Limits

Inside Outside

Distance to nearest working fire hydrant

Distance to nearest fire department

Is the property less than 1 mile from the coast?

Yes No

Distance from Coastal Waters in Feet

Distance from Coastal Waters in Miles

Sq. Ft. of New Construction

Sq. Ft. of Existing Structure

Total Sq. Ft. Area

# of Stories

# of Buildings

Approximate Distance between Buildings

Intended Occupancy

Previous Occupancy

Occupied during?

Yes No

# of weeks occupied during construction

If multiple buildings, will each building be released to owner when complete?

Yes No

Occupancy of nearest exposed structure

Distance to nearest exposed structure

Construction type of nearest exposed structure

Automatic sprinkler system:

Automatic sprinkler system

Yes No

Sprinkler system alarms:

Sprinkler system alarms

Yes No

If yes, will these systems be operational during construction?

Will sprinkler system alarms be operational during construction

Yes No

Watchman Service

Watchman service

Yes No

Watchman service hours on site

Burglar alarm system

Yes No

Fully fenced with locked entrances during non-working hours?

Yes No

Project lighted during non-working hours?

Yes No

Debris removed from site at regular intervals?

Debris removed at regular intervals?

Yes No

Frequency of debris removal

Public water supply in service at site?

Public water supply

Yes No

Brush area?

Brush area

Yes No

If yes, clearance from site?

Fire extinguishers on site?

Fire extinguishers on site

Yes No

Additional Notes (optional)

Please email the following to commercial@orchidinsurance.com.

Include the named insured and "Builder's Risk attachments" in the subject line:

Pictures (exterior and if applicable interior)
Recommendations if any
Most current construction schedule/bar chart
Site or plot plan
Geotechnical report if available
FEMA flood hazard determination
If multiple buildings, provide schedule of completion including values

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