Insurance Proposal Request

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What this form asks (47 questions, about 12 minutes)

Request a course of construction (builder's risk) insurance quote for a home being built or remodeled. Susman Insurance Agency in Los Angeles compares options; a licensed agent follows up.

  1. Name of owner (required)
  2. Date of birth (required; date)
  3. Phone (required)
  4. Email (required)
  5. Occupation (required)
  6. How did you find us? (required; choices: Search engines / Social media / News story / Referral / I am a current client of Susman Insurance)
  7. Name of referral (required; only when applicable)
  8. Marital status (required; choices: Single / Married / Divorced / Widowed)
  9. Spouse name (required; only when applicable)
  10. Street address (required)
  11. Address line 2 (optional)
  12. City (required)
  13. State (required)
  14. ZIP code (required)
  15. Street address (required)
  16. Address line 2 (optional)
  17. City (required)
  18. State (required)
  19. ZIP code (required)
  20. Purchase date of property (required; date)
  21. Purchase price (required)
  22. Square footage of property (required)
  23. Will there be an addition to the property's square footage? (required; choices: Yes / No)
  24. How many square feet will be added? (required; only when applicable)
  25. Is there a basement? (required; choices: Yes / No)
  26. How many square feet is the basement? (required; only when applicable)
  27. Description of work to be done (required)
  28. Estimated cost of job (required)
  29. Estimated length of job (required)
  30. Intended occupancy upon completion (required; choices: Primary home / Secondary home / Rental property / Vacant or for sale)
  31. Do you plan on selling the house? (required; choices: Yes / No)
  32. Will there be a 24-hour guard? (required; choices: Yes / No)
  33. Will the dwelling be locked and secured during non-working hours? (required; choices: Yes / No)
  34. Will the construction site be fenced and lit? (required; choices: Yes / No)
  35. Is there a working Central Station fire and burglar alarm? (required; choices: Yes / No)
  36. What additional security is available? (required)
  37. Name of general contractor (required)
  38. General contractor license number (required)
  39. Name of general contractor's insurance carrier and limits (required)
  40. Is the insured a builder, developer, or contractor? (required; choices: Yes / No)
  41. Please describe the insured's builder, developer, or contractor activities (required; only when applicable)
  42. Will subcontractors be hired? (required; choices: Yes / No; only when applicable)
  43. Are the subcontractors licensed? (required; choices: Yes / No; only when applicable)
  44. Do you obtain evidence of insurance from subcontractors? (required; choices: Yes / No; only when applicable)
  45. Is this a mid-term Course of Construction project? (required; choices: Yes / No)
  46. What percentage is completed? (required; only when applicable)
  47. Is this a rehab or renovation? (required; choices: Yes / No)