COURSE OF CONSTRUCTION PAGE

SUPPLEMENTAL BUILDERS RISK APPLICATION
 NEW / GROUND UP CONSTRUCTION ONLY

Items with * are required fields
   
Contractor License Number:*
License Class*

Business Name:*
Business Address:*
City:*
State:
CA
Zip:*
Owner/Contact Name:*
Business Phone:*
  Mobile Phone:
  Business Fax:
Business Email:*
 
LIMITS OF LIABILITY  
Total Completed Value of Project*

$
Temporary Storage

$
Loss Limit (if applicable)

$
Transit

$
 
DEDUCTIBLES:  ALL OTHER PERILS  *
(Catastrophe Peril Deductibles will be determined by the Company)
  $500 (Residential Only)
  $1000
 

$2500
 

$5000
 

Other
 
PROJECT INFORMATION:  
Location Address - Street*
City*
County*
State - Zip* CA
Project Type*  
  Residential
  Single Family
  Two Family
  Commercial
City Limits Inside Outside
Distance to nearest working public fire hydrant Feet  
Distance to nearest responding fire dept Miles
Distance from coastal waters Feet Miles
Total Square Foot Area
Number of Buildings
Approximate Distance Between Buildings
Number of Stories
 
Estimated Start Date of Project:*
Estimated Completion Date of Project:*
Project Currently Under Construction?:*
Yes     No
If Yes - Original Start Date:
Estimated Term of Construction:

Months
(if yes to prior to start - attach prior start questionnaire required)

% Completed

Values Completed
$
 
 
INTENDED OCCUPANCY:
Construction Type
(check one)		  
  Frame

Walls are constructed of wood or other combustible materials, including when combined with other material such as brick veneer, stone veneer, wood ironclad or stucco on wood.
  Masonry Joist

Walls are constructed of masonry materials such as clay, adobe, brick, gypsum block, cinder block, hollow concrete block, stone, tile, glass block or other similar material and where the floors and/or roof are combustible.
  Noncombustible

Walls / floors / roof are constructed of and supported by metal, asbestos, gypsum or other non-combustible material.

  Masonry Noncombustible

Walls are constructed of masonry materials of the type described in masonry joist above but with a floor and roof constructed of metal or other non-combustible material.

  Fire Resistive
Walls / floors / Roof are constructed of fire resistive materials having a resistance rating of not less than two (2) hours.

REFERENCE TO WALLS MEANS THE STRUCTURAL FRAME AND SUPPORT WALLS.
REFERENCE TO FLOORS MEANS THE FLOORS AND SUPPORTS. REFERENCE
TO ROOF MEANS THE ROOF DECK AND SUPPORTS
 
Nearest Exposed Structure:
  Occupancy:
  Nearest To:
  Construction Type:
Are buildings transferred to permanent coverage once completed? Yes     No

If yes to above - please indicate maximum # of buildings under
construction at any one time and the corresponding values:
 
SITE SECURITY:
Site Fenced? Yes     No
Site Lighted? Yes     No
Watchman service on site during all
non-working hours?		 Yes     No
Hours on Site
 
LOSS CONTROL:
Debris removed from site at
regular intervals?		 Yes     No Frequency
Public water supply in service at site? Yes     No
Brush area? Yes     No  If yes - clearance from site
 
MISCELLANEOUS:
Provide any additional information available
(windspeed design, special construction features, mortgage holder, loss payee etc):
 
   

 

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