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 *

Street *

City *

State *

ZIP / Postal Code *

E-Mail Address *

Primary Phone Number *

Alternate Phone Number

Contact Name

Company Owner

First Name *

Last Name *

Nature of Business

Years of Experience

Number of Owners

Gross Annual Sales

Number of Employees

Annual Employee Payroll

Subcontractors Used

Annual Cost of Subcontractors

Additional Information

Prior Insurance

Length of Coverage (Months and Years)

How many additional insureds are required?

How did you hear about us?

Counties of Operation

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

Do you do any Commercial Construction

Average Gross Receipts from Commercial Work

Describe typical projects:

Do you require subcontractors to carry General Liability insurance?

Do you require all subs to carry Workers Comp?

Do you have written contracts with your subs?

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

Current General Liability Insurer:

Current Workers Compensation Insurer

Current Builders Risk Insurer

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

Homebuilders Information

Number of Homes Projected in the next 12 months

Average Price Range

Do you Build

Single Family
Condos
Townhomes
Apartments

Developers (Optional)

Do you develop lots?

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

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

If Yes, how many acres?

Remodeling Information (Optional)

Number of projects per year

Describe typical projects:

Average hard cost

Submission Validation

Required

Important Notice
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