Policy Type: |
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Address: |
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City: |
State:
Zipcode: |
County: |
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Provide a brief description of the structure to be renovated and condition of the existing structure |
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Project Start Date: |
Completion Date: |
Has the project started? |
Yes / No
If "Yes", dated started
Percentage Complete: If "No", will project start within 60 days of the policy effective date: Yes / No |
Scope of Work:
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Remodel Remodeling of interior finishes; exterior
painting; replacement of interior fixtures, cabinets, flooring, etc. No
structural changes.
Remodel/Minor Structural Remodel work as listed
above and minor changes to exterior (doors, windows, skylights, etc.).
Roof replacement, ground floor additions and all non-structural changes
such as HVAC, plumbing and electrical.
Restructuring Repair, replace, remove load
bearing walls. Adding additional stories, adding stairways or elevators.
Foundation work such as underpinning and/or dewatering. |
Value property at all locations: |
$
DEDUCTIBLE:
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Amount of Renovation/Improvements:
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$ |
Existing Building(s) or Structure(s) Amount:
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$ |
Backup of Sewers, Drains & Sumps: |
$ |
Debris Removal:
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$ |
Fire Department
Service Charge:
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$ |
Pollution Cleanup & Removal: |
$ |
Reward: |
$ |
Scaffolding, Construction Forms, and Temporary Structures: |
$ |
Scaffolding Re-Erection: |
$ |
Property at a Temporary Storage Location: |
$ |
Property in Transit: |
$ |
Valuable Papers & Records: |
$ |
Change Order Endorsement: |
Not Applicable /
10% increase /
20% increase /
30% increase |
Earthquake Coverage: |
$ |
Flood Coverage: |
$ |