Builder's Risk Quote

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.

First Name *

Last Name *

Named Insured *

Street Address/Mailing Address *

City *

State *

ZIP / Postal Code *

Primary Phone Number *

E-Mail Address *

Legal Name of Builder (include entity type) *

Builder's Address/City/State/Zip *

Builder's years in business *

Builder's years' experience *

Applicant is *

Type of Risk *

Risk Address (address/city/state/zip) Must Include Zip Code *

Total Cost of Construction (not including land) *

Project Start Date *

Project End Date *

Type of Construction (frame, joisted masonry, etc) *

Number of Stories *

Square Footage *

Deductible ($1,000; $2,500; $5,000; other) *

Protective Measures (fencing, lighting, security, etc.) *

Any BR claims in the last 5 years? *

Is profit included in the construction values? *

Complete this section if project is a remodel/renovation:

Coverage needed for existing structure?

Any structural work?

If "yes" to structural work, please describe

Are there changes to the roof line?

Actual Cash value of existing structure

Replacement Cost value of renovations

Provide thorough description of renovations, including details of any structural work

Submission Validation

Required

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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Phone: 214-301-3333 | info@brookstone-group.com