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 Optional
Gross Annual Sales Optional
Number of Employees Optional
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	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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