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Historic Builders Risk Questionnaire - NTIS BR Summer 2023

Home » Our Forms » NTIS Historic Builders’ Risk Questionnaire

Every construction project is different. Consider filling out our form and we’ll get back to you soon.

Get the insurance coverage your historic construction project needs.

Please complete the form to your best ability. Fields marked with an * are required.

"*" indicates required fields

Step 1 of 5

20%

This field is for validation purposes and should be left unchanged.

Applicant Information

Name*

First Name* Last Name*

Email*

Name of Contractor (if different)

Contractor Website

Project Timeline Information

Estimated start date of project*

MM slash DD slash YYYY Estimated start date of project*

Estimated completion date of project*

MM slash DD slash YYYY Estimated completion date of project*

Project currently under construction?

Yes

Estimated Term of Construction

Months*

% Completed*

Values Completed*

Project Coverage (must be checked)

Existing Structure*

New Construction*

Soft Costs*

In-transit*

Loss of Rents*

Project Coverage (must be checked)*

$5,000

$10,000

$25,000

$50,000

Other

Catastrophe peril deductibles will be determined by the company.

Project Information

Location Address*

Street Address* Address Line 2 City* State* ZIP Code*

Public Protection Class*

Number of Buildings*

Total Square Feet Area*

City Limits*

Inside

Outside

Approximate distance between nearest buildings*

Number of Stories*

Intended Occupancy*

Construction Type*

Frame

Masonry Joist

Noncombustible

Masonry Noncombustible

Fire Resistive

Nearest Exposed Structure

Occupancy*

Distance To*

Construction Type*

Does this project include upgrades to...

Roofing

Plumbing

Electrical

HVAC

Is there adequate fire alarm protection during demolition, building preparation, and construction?*

Yes

Does this project include construction to load bearing walls? If “yes”, please include a Structural Report.

Yes

Structural Report

Will this project involve the installation of a sprinkler system?*

Yes

Do you plan to install solar panels? If yes, list which buildings.*

Yes

List buildings planned to have solar panels installed here.

Site Security

Site storage?*

Yes

Site lighted?*

Yes

Site fenced?*

Yes

Doors and windows secured?*

Yes

Watchman service on site during all non-working hours?*

Yes

Hours on Site (AM/PM)

From

Until

Loss Control

Debris removed from site at regular intervals?*

Yes

Public water supply in service at site?*

Yes

Brush area?*

Yes

Miscellaneous

Provide any additional information available about the project (wind speed design, special construction features, mortgage holder, loss payee, etc.)

Disclaimer and Signature

The undersigned is an authorized representative of the Applicant and certifies that reasonable investigation and inquiry has been made to obtain the answers to questions on this questionnaire. When providing information for purposes of requesting a renewal, if applicable, the Applicant has carefully reviewed the prior questionnaire to ensure that the Insurer has been provided with updated information. The undersigned certifies that the answers are true, correct, and complete to the best of his/her knowledge.

By hitting submit you are certifying your submission.

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