Phone: 818-368-3561 - Facsimile: 818-366-2455

P. O. Box 7817 - Northridge, CA 91327-7817

REQUEST FOR BUILDERS RISK POLICY QUOTATION

1. AGREED PRODUCER: CONTRACTORS & MANUFACTURES INSURANCE SERVICES
2. INSTRUCTIONS: Complete this form and fax or E-mail it to CMIS
3. NAMED INSURED:
MAILING ADDRESS:		  
 
4. ADDITIONAL INSUREDS/
LOSS PAYEE		  
5. PROJECT DESCRIPTION:  
A. TYPE:  
B. CONSTRUCTION MATERIALS:  
C. NO. STORIES ABOVE GRADE:  
D. NO. BASEMENTS  
E. NO. SEPARATE BUILDINGS  
6. PROJECT LOCATION  
7. ESTIMATED CONSTRUCTION PERIOD
(PERIOD OF INSURANCE)		 A. Commencement Date: _____
B. Scheduled date of Completion: _____
8. PROTECTION
FENCED AND LIGHTED
(a warranty unless in a guarded community) 		A. NATIONAL BOARD CLASS:
B. FIRE PREVENTION METHODS:
C. SITE TO BE FENCED?
D. NIGHT HOURS OF SECURITY -
PERMANENT DRIVE BY
9. SUMS INSURED:

If several buildings in project, please send plot plan.		 A. BUILDERS RISKS - ALS form - All Risks, exclude quake & flood
i. TOTAL $_________
ii. Maximum value any one building or group of connections Buildings $________
B. SOFT COSTS $_________ C. TRANSIT $_________
D. AT OTHER LOCATIONS LIMIT $__________
(1) ADDITIONAL CONSTRUCTION FINANCING INTEREST $__________
(II) LOSS OF RENTS (12 MONTH INDEMNITY PERIOD) $_________
10. DEDUCTIBLE: IN US $ 2,500
11. INSURED'S SIGNATURE: X

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Please print a copy of this form, complete it, and fax it to 818-366-2455
We will call you if we need more information.

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