Builders Risk Discovery in San Antonio, TX

Contact Person's Name(Required)

First Last

Cell Phone Number(Required)

Email Address(Required)

Business Entity Name

Organization Type(Required)

Number of Owners(Required)

Mailing Address(Required)

Street Address City State ZIP / Postal Code

What does your current RE portfolio consist of?(Required)

This is my only RE property (other than primary residence)

I have 5 or less RE properties

I have more than 5 RE properties

What coverage is your business interested in?(Required)

Builder's Risk

Premises Liability

Check all that apply

Risk Exposure

Please provide the following detailed information regarding the property for which you are seeking coverage.

Property Address(Required)

Street Address City State ZIP Code

Date Property Purchased(Required)

MM slash DD slash YYYY

Approx date work will begin:(Required)

MM slash DD slash YYYY

Who will be doing the work?(Required)

Owner/Insured

General Contractor

Owner/General Contractor

How many years of industry experience(Required)

Intended occupancy after work is completed:(Required)

Rental

For Sale

Unknown

Purchase price(Required)

Estimated Construction Cost (Labor & Materials Included)(Required)

Current Sq ft:(Required)

For New Builds, enter the estimated finished sq ft

Will you be adding sq ft to the existing structure?(Required)

Yes

Current Number of Stories(Required)

For New Builds enter the number of stories/levels that will be built.

Will you be adding additional stories/levels to the existing structure?(Required)

Yes

Year ELECTRIAL was last updated:(Required)

For new builds, enter the current year.

Type of ELECTRICAL:(Required)

Year PLUMBING was last updated:(Required)

For new builds, enter the current year.

Type of PLUMBING:(Required)

Year HVAC was last updated:(Required)

For new builds, enter the current year.

Type of HVAC:(Required)

Year ROOFING was last updated:(Required)

For new builds, enter the current year.

Type of ROOFING:(Required)

How long will it take to complete the work?(Required)

Please consider that materials and labor are still taking longer than normal in your estimate.

Is the existing structure going to be insured on any other insurance policy?(Required)

No - Include existing structure on this policy

No - I do not wish to insure the existing structure

Yes

N/A - this is a new build

Will there be any structural work done on the property?(Required)

For new builds, check "Yes"

Yes

Please advise what structural work will be completed:(Required)

New Build

Adding Sq Ft to existing structure

Roof Pitch change

Foundation

Removing/moving interior load bearing walls

Other (please specify other work on the next page)

Engineers Report(Required)

Do you agree to email us a copy of the engineers report showing the structural integrity to include the engineer's name.

Contractor name:(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone

How many years of experience does the contractor have?(Required)

Please provide a detailed explanation of the work you will be doing to the property below.(Required)

How did you first hear about us?(Required)

Current Customer

Family/Friend Referral

Channel Partner Referral (Mortgage Broker, Realtor, Other Insurance agent)

Google Search

Social Media Post (Facebook, Instagram, Twitter)

Local Event

Other

File upload

You can upload any engineers report, scope of work or insurance requirements to help us determine the best insurance program to put in front of you.

Drop files here or

Max. file size: 5 MB, Max. files: 5.

Consent(Required)

Do you agree & consent to the following:

All the information submitted on the application is true and correct to the best of my knowledge.

By submitting this request you are authorizing My Insurance Group, its affiliates and carrier partners the access to pull the necessary reports (i.e. claims, credit, and loss history) to confirm the data submitted.

Submitting your quote request does not constitute a binding confirmation of a new or revised insurance coverage.

My Insurance Group is committed to respecting your privacy and communication preferences. So that we may remain compliant with state and federal regulations, we need your expressed permission to communicate with you through phone, text and email as needed.

You may opt-out of all future communication at any time by making your preferences known to us.

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Builder's Risk Discovery Form

Risk Exposure