Application – Builders Risk – Orr and Associates

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800-858-1315

7am - 5pm PST
Monday - Friday

Builders Risk

Your Name*
First Last
Business Name (if applicable)
Phone Number*
Email*

Project Location
Street Address City State ZIP Code

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
- No
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
- No

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

Mailing Address
Mailing Address
Street Address City 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

800-858-1315

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