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

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Company Owner

First Name

Required

Last Name

Required

Nature of Business

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Years of Experience

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Number of Owners

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Gross Annual Sales

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Number of Employees

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Annual Employee Payroll

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Subcontractors Used

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Annual Cost of Subcontractors

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Additional Information

Prior Insurance

Optional

Length of Coverage (Months and Years)

Optional

How many additional insureds are required?

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How did you hear about us?

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Counties of Operation

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

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Do you do any Commercial Construction

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Average Gross Receipts from Commercial Work

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Describe typical projects:

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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?

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

Optional

Current General Liability Insurer:

Optional

Current Workers Compensation Insurer

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Current Builders Risk Insurer

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

Optional

Homebuilders Information

Number of Homes Projected in the next 12 months

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Average Price Range

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Do you Build

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Single Family
Condos
Townhomes
Apartments

Developers (Optional)

Do you develop lots?

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

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

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If Yes, how many acres?

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Remodeling Information (Optional)

Number of projects per year

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Describe typical projects:

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Average hard cost

Optional

Submission Validation

Required

Enter the Validation Code from above.

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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