BUILDER’S RISK APPLICATION

When available please provide:

Breakdown of values for the various structures and types of work

Site plan indicating distance, construction, and occupancy of exposure

Schedule of construction

Summary and Recommendations for the geotechnical report

Schedule indicating Build-up of construction values

Applicant’s Name (Legal and Operating):	Broker: Brokerage:
Applicant’s Address:
Name of Project:
Project Address:
Project Description:
Project Participant Names:
Owner: Project Construction Manager: General Contractor: Prime Architectural/ Engineering Consultant: Geotechnical Engineer: List of Sub-contractors (or as attached)
Sub-Contractors
Does Applicant check previous experience and history of sub-contractors? No Yes
Construction Period From: to:
Policy Period: From: to: If the policy term differs from Construction Period please explain why:
Construction Features
Height of Structure:	Storeys:	Feet or Metres:
Below grade:
Above Grade:
Total Area (indicate sq. Feet or sq. metres):
Construction Materials:
Framework:
Exterior Walls:
Roof:	Structure:	Covering:
Floor:	Structure:	Covering:
Adjacent Structures (attach site plan if available)
Type of Construction	Occupancy	Distance
North
East
South
West
Security
Is site Fenced?	Yes	No	Height/ Type:
Is Site lit?	Yes	No
Watchman service?	Yes	No	Hrs./ Rounds:
Alarm	Yes	No	Alarm sounds to:
Neighborhood (Describe):
Subsurface Operations
Describe the nature, duration, value, and relationship to both the project and to adjacent structures.
Blasting:
Shoring:
Pile Driving:
Underpinning:
List Project Manager’s/ General Contractor’s 5 largest projects in the past 5 years
Name	Type	Location	Value ($1, 000’s)
Financials
Does the General Contractor have a Performance Bond for this project? Yes No
Name of Surety Company Bond #:
Builder’s Risk Particulars
Total Estimated Project Value (Attach breakdown)
Hard cost: Labour, materials, professional fees to enter into and form part of the project) $
Soft cost: Finance costs, additional interest, leasing and marketing expenses, legal and accounting expenses, other carrying costs) $
Other Property to be Insured $
If coverage is required to existing structure, equipment to be furnished, by the owner, etc. detail age, construction, condition, occupancy of such property
Coverage	Limits ($)	Deductible ($)
Value of Project
Other Property to be Insured
Sublimits
Soft Costs (other than Delayed Start-ups)
Delayed Start-up
Offsite
Transit
Testing (electrical/ mechanical breakdown during commission)
List offsite locations and maximum value at each:
Transit
List key items (individual items over $100,000 value) point of origin, location where responsibility is accepted (F.O.B)
Testing
a) Who will perform testing operations?
b) Describe operations involved in testing and commissioning:
c) Will the project involve installations of any used equipment? Yes No
Location Information
a) Distance to nearest Fire Department:
b) Name of City or Town providing protection:
c) Hydrants (operational) Number within 1,000 ft
d) Number of fire extinguishers situated on the construction site:
e) Will the project have sprinklers? Yes No
If so, at what time will the system be in operation?
Construction Data
a) Has a geotechnical report been completed?
If not, explain why
b) Will the project be constructed in compliance with geotechnical recommendations?
Yes No With modifications, describe modifications in detail:
c) If geotechnical report’s summary and recommendations are not available, describe soil conditions:
d) Type of foundation for each structure:
e) Are wood forms to be used? Yes No
f) Describe any unusual or experimental features in construction or design:
g) Describe any special features (ex: stained glass, glass curtain walls, artwork) to be incorporated or included:
Flood Exposure
a) Nearest body of water: Name: Distance to:
b) Past flood history at site:
c) Height of project above maximum flood stage:
d) Describe exposure during and after excavation from surface water:
e) Describe precautions to be taken to prevent damage from flood:
f) What is being done to prevent run-off damage?
Site Risks
Detail exposure from:
a) Winter heating conditions (type of heaters)
b) Explosion (detail use of any highly flammable or explosive materials to be present on site)
Provide details of LOSS CONTROL PROGRAM to be implemented to protect insured property:
Claims Experience
Detail any Builders Risk or Installation Floater claims (exceeding $10,000 per loss) incurred by any of the following during the past 5 years: Owner, General Contractor, Project/ Construction Manager. Indicate the date, amount, and nature of the claim.
It is understood and agreed that the completion of this application does not bind the insurers to sell, nor does it oblige the applicant to purchase the insurance.
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Signature of Applicant	Date
__________________________________________ ___________________________________________
Submitted By	Email