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Zurich Builders Risk Application Checklist
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Phone
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Your Email
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Insured Information
Insured Name
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Mailing Address
(Required)
Street Address
Address Line 2
City
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Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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Guam
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Northern Mariana Islands
Ohio
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Oregon
Pennsylvania
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Physical Address?
Mailing address is the same as the Physical Address
Physical Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Named insured
(Required)
Owner / Contractor
Owner
Contractor
Business type
(Required)
Corporation
Individual
Joint Venture
LLC
Partnership
Other
Builder Information
Name
(Required)
Years of experience
(Required)
Loss History
(Required)
Please share details, if any
Remodeling Scope of Work
Scope selection
(Required)
Remodel - Remodeling of interior finishes; exterior painting; replacement of interior fixtures, cabinets, flooring, etc. No structural changes.
Remodel/Minor Structural - Remodel work as listed above and minor changes to exterior (doors, windows, skylights, etc.). Roof replacement, ground floor additions and all non-structural changes such as HVAC, plumbing and electrical.
Restructuring - Repair, replace, remove load bearing walls. Adding additional stories, adding stairways or elevators. Structural retrofitting or foundation work such as underpinning and/or dewatering
Renovation Description
(Required)
Architectural plans developed
(Required)
Yes
No
Licensed engineer reviewed
(Required)
Yes
No
Engineer / firm name
(Required)
Solar installation
(Required)
Yes
No
Coverage information
Amount of renovation/improvements
(Required)
(Note: Greater than $1,500,000 will require underwriter approval)
Existing building(s) or structure(s) amount (ACV)
(Required)
Desired Deductible
(Required)
$1,000
$2,500
$5,000
$10,000
$25,000
Desired Coverages
(Required)
Extra Expense
Earthquake
Flood
Testing
Equipment Breakdown
5% Inflation Guard
Soft Costs
Extra Expense Coverage Amount
(Required)
Earthquake Coverage Amount
(Required)
Flood Coverage Amount
(Required)
Soft Costs Coverage Amount
(Required)
Renovation Information
Existing structure insured elsewhere
(Required)
Yes
No
Historical registry listing
(Required)
Yes (underwriter approval required)
No
Date structure purchased
(Required)
Month
Day
Year
Condition of existing structure
(Required)
Poor Condition - Uninhabitable, siding/shingles missing, dilapidated, overgrown landscaping, fire damaged, flooded, vandalized or stripped of copper. Major repairs needed.
Fair Condition - Lacks maintenance and/or minor repairs are needed to bring into average condition.
Good Condition - Well maintained and little/no evidence of deferred maintenance. Minimal repairs can be quickly and affordably resolved and are only cosmetic in nature.
Structure description
(Required)
Interest information
Additional interests
(Required)
Yes
No
Additional interest details
(Required)
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