800-858-1315 7am - 5pm PST | Monday - Friday Builders Risk Application "*" indicates required fields First and Last Name* Business Name (if applicable) Phone* Email* Project DetailsIs this a new construction or remodel project?* New Construction Remodel Is this a residential or commercial project?* Residential Commercial Other Has the project already started?* Yes No Project Start Date* MM slash DD slash YYYY Percentage Completed5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%From the beginning of the project until now, have there been any incidents or damage that may give rise to a claim?* Yes No Applicant InformationWhat is your relation to the project?* Contractor Homeowner Owner/Contractor What is your relation to the project?* Contractor Business Owner Owner/Contractor Name of Building Contractor* Name of Owner* Total Completed Project ValueDo you need coverage for the existing structure? Yes No, coverage is for the renovation only. Value of Existing Structure Project LocationAddress Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing AddressMailing Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Any other projects anticipated in the next calendar year?* Yes No Are there or will there be any additional structures on the property?* Yes No Are you within 1000 feet of a fire hydrant or water supply?* Yes No Are you within 5 miles of a fire station?* Yes No Will the structure be occupied during construction?* Yes No Any structural work?* Yes No Year Original Structure Was Built Check All That Apply Work On Foundation Shoring or Underpinning Work on Load Bearing Walls Elevators Staircases Room Addition Number of Stories 1 2 3 or more Square Footage (including basement)*Construction Type Frame Joisted Masonry Non-Combustible Masonry Non-Combustible Fire Resistive Unknown Anticipated Completion Date* Month Day Year © 2022 Orr & Associates Insurance Services National Producer Number 8395753