ARM-Capacity ~ Quote - Builders Risk Insurance

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888.ARMofNY (276-6369)

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Builders Risk / Construction
Insurance Quote Submission

Broader Coverage - Lower Premium!
Find Out Now - Get a quote!

ARM-Capacity - Leading the way in Builders Risk insurance coverage!

Complete the following information to obtain a Builders Risk Quote.

GENERAL INFORMATION

Name of Insured / Corporation:

DBA (if applicable):

Mailing Address:

City:

State: Zip:

Company Web site Address

Year Business Started

Any Claims / Losses YES No

Ever Filed Bankruptcy or Reorganization YES No

Developer or General Contractor

Limits Required for Subcontractors

Has Coverage Been Declined,
Cancelled or Nonrenewed in Last 3 Yrs? YES No

PHYSICAL LOCATIONS (if more than 5 include in Notes Section on Bottom of Page)

Street Name City State Zip

LOC 1.

LOC 2.

LOC 3.

LOC 4.

LOC 5.

NEW CONSTRUCTION (if applicable) YES NO

# Homes Built
Last 12 Months Est. Homes
Next 12 Months # Spec Homes
Last 12 MOnths Est. Spec.Homes
Next 12 Months

Avg. Length of Construction
(in months) Completed Value per Dwelling
(Excl. lot) Max. Completed Value of Home
(Excl. lot) Avg. Sales Price per Dwelling Max. Sales Price per Dwelling

# of Homes Built Last Yr.

Est. # Homes Built In Next 12 Months

Do You Build in Multiple Subdivisions? YES No

Any Over 3 Stories in Height? YES No

Any Over 4 units? YES No

Do you Plan on Remodeling Homes? YES No

Construction Type

MODEL HOME (if applicable) YES NO

# of Models to Insure Avg. Model
Home Value Max. Model
Home Value Avg. Contents Value Max. Contents Value

Any Models Over 3 Stories? YES No

Do Models Have Active Security Alarms? YES No

Age of Models

Construction Type

MULTIFAMILY (if applicable and over 4 units) YES NO

Completed Value

Number of Units

Construction Type

Number of Stories

Approx. Start Date / End Date

More Than 1 Building YES No

# of Buildings

If More Than 1 Building - Distance Between?

Prior Experience Building Multi-family YES No

FIRE SAFETY INFORMATION

Distance from Hydrant

Distance to Fire Department

Is Fire Dept. Volunteer or Paid? VOLUNTEER PAID

COVERAGE INFORMATION

Do You Want to Exclude Profit? YES No

Limit at Any One Dwelling

       Other Coverage Limit

Limit in Any One Loss

       Other Loss Limit

Deductible

       Other Deductible

CONTACT INFORMATION

First Name:

Last Name:

*Email:

Phone: Fax:

Notes / Comments:

When Do You Need Quote?

How Did You Hear About Us?

Thank you for completing this form

ARM-Capacity's Policy on sharing information:

We will only use information provided to assist in obtaining appropriate insurance quotes and coverage.
We will not distribute information to other parties other than for insurance underwriting purposes.

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FAX: 212.937.3923

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