Builder's Risk Property Insurance
Business Name:
(if any)
  Form of Business:
Contact Name:
 State:    Zipcode:
Email Address:
Description of Insured:
Owner/Contractor  Owner  Contractor

Property Location:            
Policy Type:
   State:    Zipcode: 
Provide a brief description of the structure to be renovated and condition of the existing structure
Construction Material Year Built
(if existing structure)
Total Square Footage
(including Basement)
Type of Construction
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:
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:
Amount of Renovation/Improvements:
Existing Building(s) or Structure(s) Amount:
Backup of Sewers, Drains & Sumps:
Debris Removal:
Fire Department Service Charge:
Pollution Cleanup & Removal:
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:
General Questions
Is existing structure coverage desired? Yes No
Will structure be occupied during construction?
If "YES", by whom?
Is the builder's name different than the named insured?
If yes, enter builder's name: 
Yes No
Do you have any additional insureds? Yes No
Does the building have an operable sprinkler system?
Is the existing structure listed on any historical registry or subject to a historical society regulation?
Has the existing structure been moved or will it be moved as part of this project?
Date existing structure was purchased
Modular Home Construction.....
Is the structure modular? Yes No
Who provides transit coverage......................?
How are homes transported to the job site.....?
Estimated time to complete each structure.....
Does the manufacturer put the four sides together and then the builder finish it off? Yes No
Does the manufacturer have a web site address? (Web Site: ) Yes No
Apartments, Condominiums or Multi-Unit Structures....
Is the location apartments, condominiums or multi-unit structure(s)?
Number of buildings
Number of units per building
Value per building
Distance between buildings
Total project completed value
Start and completion date of each building to
Will the structure be occupied during construction?
If yes, describe:
Yes / No
Yes No
Any coverage for development / subdivision fences, walls or signs? If yes, value:$ Yes No
Does builder/remodeler have at least 2 years experience?
Type of Builder:
Yes No
Any foundation, structural changes or movement of load bearing walls? Yes No
Is the contractor insuring more than one building being constructed within 100 feet from each other at this project site?
If yes, please provide total estimated completed value of all structures under construction within 100 feet and insured with Zurich, including this one: $
Yes No
Number of structures built/remodeled during the past 12 months?1 - 2 | 3 - 50 |  Other ()
Number of structures projected for the next 12 months? 1 - 2 | 3 - 50 | Other ()

Loss experience for last 3 years?

Mortgagee on Property
Mortgagee Name
  State:    Zipcode: 

M c G R A T H   I N S U R A N C E   G R O U P

4170 William Penn Highway, Murrysville, PA. 15668-1890
(724) 327-8474              (FAX) (724) 327-7911
Toll Free: 1-800-977-2999        Fax: 1-888-800-0034