Fill out an application for Builders Risk Insurance

General Information
For assistance, call Zurich InsuranceLink at 1-800-431-4823, 7:30 am to 7:30pm ET, Monday through Friday. Required Fields * First Name: * Last Name: * Title: (If builder / remodeler) Company: (If builder / remodeler) Mailing Address: * City: * State: Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Zip Code: * Phone Number: * E-mail Address: * Privacy Policy Loan Settlement Date/Policy Effective Date: *
Property Information
Type of Coverage* New Construction Coverage Remodeling Coverage Is there a hydrant within 1000 feet of the property?* Yes No Is there a fire department within 5 miles of the property?* Yes No Is structure to be remodeled less than 75 years old?* Yes No Will there be structural changes to the existing structure?* Yes No Is the existing structure to be insured on this policy?* Yes No Please include the value of the existing structure with the completed value of the remodeling below. Please do not include the value of the existing structure with the completed value of the remodeling below.
Projected Completed Value of Structure: $* Construction Site Location Site Address: * Site City: * Site State: Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Site Zip: * (Contract price minus cost of land, usually 20-25%)
When would be the best time to contact you? Please select 7:30 am to 10:30 am (EST) 10:30 am to 1:30 pm (EST) 1:30 pm to 4:30 pm (EST) 4:30 pm to 7:30 pm (EST) *

This on-line application is not an insurance policy nor is it an offer of insurance. The coverages set forth in response to this online application are based on the information you have entered thereon and may not include all available coverages. You and InsuranceLink should discuss any additional or optional coverages that may be appropriate for your particular risk exposures.

This online application is not a part of the insurance policy and is not incorporated therein.The insurance policy supersedes this on-line application in all respects.

APPLICABLE IN FLORIDA STATE
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURER FILES A STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE, INCOMPLETE, OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE.

APPLICABLE IN NEW YORK STATE
Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and shall be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

Do you need assistance? Call one of our licensed professional Agents at 1-800-431-4823 from 7:30 AM to 7:30 PM EST, Monday through Friday. Receive a No Obligation Quote over the phone.