Homebuilder Questionnaire

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Company Information

Company Name

Required

Street

Required

City

Required

State

Required

ZIP / Postal Code

Required

E-Mail Address

Required

Primary Phone Number

Required

Alternate Phone Number

Optional

Contact Name

Optional

Company Owner

First Name

Required

Last Name

Required

Nature of Business

Optional

Years of Experience

Optional

Number of Owners

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Gross Annual Sales

Optional

Number of Employees

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Annual Employee Payroll

Optional

Subcontractors Used

Optional

Annual Cost of Subcontractors

Optional

Additional Information

Prior Insurance

Optional

Length of Coverage (Months and Years)

Optional

How many additional insureds are required?

Optional

How did you hear about us?

Optional

Counties of Operation

Optional

Do you act as a Sub Superintendent or Project Manager for Other Builders?

Optional

Do you do any Commercial Construction

Optional

Average Gross Receipts from Commercial Work

Optional

Describe typical projects:

Optional

Do you require subcontractors to carry General Liability insurance?

Optional

Do you require all subs to carry Workers Comp?

Optional

Do you have written contracts with your subs?

Optional

Do you offer a Warranty outside of the standard One Year Builder Warranty?

Optional

Current General Liability Insurer:

Optional

Current Workers Compensation Insurer

Optional

Current Builders Risk Insurer

Optional

Claims/Property Losses in Past 5 Years (Please Explain)

Optional

Homebuilders Information

Number of Homes Projected in the next 12 months

Optional

Average Price Range

Optional

Do you Build

Optional

Single Family
Condos
Townhomes
Apartments

Developers (Optional)

Do you develop lots?

Optional

If yes, do you sell to other builders or build homes yourself?

Optional

Any Vacant Land/Real Estate Development Property owned by the company?

Optional

If Yes, how many acres?

Optional

Remodeling Information (Optional)

Number of projects per year

Optional

Describe typical projects:

Optional

Average hard cost

Optional

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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