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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



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
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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.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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