Builders Risk Application – Orr & Associates Insurance Services

This field is hidden when viewing the form

Agent Email

Your Name*

First Last

Business Name (if applicable)

Phone*

Email*

By entering my phone number and/or email, and clicking “Next”, I agree to receive recurring marketing emails, calls, and texts at the number I provided to Orr & Associates Insurance Services even if my number is on a Do Not Call list. Consent is not a condition of purchase; opt-out anytime. Msg & data rates may apply. View our Terms of Service for details. If you have questions or to opt-out, please call us at 800-311-3081.

Project Details

Is 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

Project Start Date*

MM slash DD slash YYYY

Percentage Completed

From the beginning of the project until now, have there been any incidents or damage that may give rise to a claim?*

Yes

Applicant Information

What 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 Value

Do you need coverage for the existing structure?

Yes

No, coverage is for the renovation only.

Value of Existing Structure

Project Location

Address

Street Address City State ZIP Code

Mailing Address

Street Address City State ZIP Code

Any other projects anticipated in the next calendar year?*

Yes

Are there or will there be any additional structures on the property?*

Yes

Are you within 1000 feet of a fire hydrant or water supply?*

Yes

Are you within 5 miles of a fire station?*

Yes

Will the structure be occupied during construction?*

Yes

Any structural work?*

Yes

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

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

Email Consent

By entering my email and clicking “Get My Quote,” I agree to receive recurring marketing emails from Orr & Associates Insurance Services. Consent is not a condition of purchase; I may opt out at any time.

Phone Call Consent

By entering my phone number and clicking “Get My Quote,” I agree to receive recurring marketing and informational calls from Orr & Associates Insurance Services, even if my number is on a Do Not Call list. Consent is not a condition of purchase; I may opt out at any time.

SMS Text Consent

By entering my phone number and clicking “Get My Quote,” I agree to receive recurring marketing and informational texts from Orr & Associates Insurance Services, even if my number is on a Do Not Call list. Message and data rates may apply. Consent is not a condition of purchase. Reply STOP to opt out or HELP for help.