Builders Risk Please complete all required fieldsYour InformationFirst Name *Last Name Company Name Contact Number Facsimile Number Email Address *Builders Risk/COCProperty / Project State Property / Project County Property / Project City Property / Project Zip Property / Project Address Square Footage of Construction Type of Project New ConstructionRemodeling / Renovation EXCLUDING coverage for the existing structureRemodeling / Renovation INCLUDING coverage for the existing structureType of Property Residential 1 - 4 single family dwellingCommercialConstruction Material FRAME – EXTERIOR WALLS CONSTRUCTED OF WOOD OR OTHER COMBUSTIBLE MATERIALS SUCH AS BRICK VENEER, WOOD, STUCCO ON WOOD.JOISTED MASONRY – EXTERIOR WALLS CONSTRUCTED OF MASONRY MATERIALS SUCH AS BRICK, BLOCK, STONE OR SIMILAR MATERIALS AND THE ARE OF WOOD CONSTRUCTION. FLOORS AND ROOFNON-COMBUSTIBLE – EXTERIOR WALLS, FLOORS AND ROOF CONSTRUCTIED OF METAL, GYPSUM OR OTHER NON-COMBUSTIBLE MATERIALS.OMASONRY NON-COMBUSTIBLE – EXTERIOR WALLS, FLOORS AND ROOF CONSTRUCTED OF MASONRY OR FIRE RESISTIVE MATERIALS WITH FIRE RESISTANCE RATING OF NOT LESS THAN 1 HOURFIRE RESISTIVE – EXTERIOR WALLS, FLOORS AND ROOF CONSTRUCTED OF MASONRY OR FIRE RESISTIVE MATERIALS WITH A FIRE RESISTANCE RATING OF NOT LESS THAN 2 HOURS.Total Completed Value of Any Structure Labor Cost Material Cost Deductible Application Information THIS APPLICATION CONTAINS THE INFORMATION NEEDED TO START YOUR POLICY. IN SOME CASES IT MAY BE NECESSARY TO TRANSFER THIS INFORMATION TO ONE OR MORE CARRIER SPECIFIC FORMS. IF THAT IS NECESSARY WE WILL COMPLETE THEM FOR YOU AND SIGN ON YOUR BEHALF WITH THE INFORMATION FROM THIS APPLICATION. CLIENT AGREES TO INDEMNIFY AND HOLD HARMLESS TOP CONTRACTORS INSURANCE, ANY OF ITS EMPLOYEES AND AGENTS, ALONG WITH ANY OF ITS AFFILIATED COMPANIES FROM AND AGAINST ANY AND ALL CLAIMS ARISING OUT OF OR RELATION TO ANY ALLEGED FAILURE TO ACT ON THE PART OF THE CLIENT WHICH RESULTS IN ANY CLAIM, DEMAND, ACTION, OR CAUSE OF ACTION AGAINST TOP CONTRACTORS INSURANCE SERVICES INC, OR ITS AFFILIATED COMPANIES. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank
