Builder'S Risk Insurance Binder Request Form printable pdf download

Builder'S Risk Insurance Binder Request Form

Builder’s Risk Insurance Binder

Request

To:

Date:

From:

Project:

The contract speciﬁ cations for the above referenced project require that Builder’s Risk insurance coverage is

to be secured by the Owner on behalf of all participating Contractors.

This letter contains the information your insurance agent will need to secure the insurance required for this

project. The following speciﬁ c information must be included in the policy:

CONTRACT AMOUNT -

including value of Owner-supplied materials and

equipment if any

(Including sales tax): $

Broad Perils Builder’s Risk – without Earthquake and Flood, but including Resultant Damage from Faulty

Workmanship and Material, errors in design, plans or speciﬁ cations.

Broad Perils Builders Risk - including Earthquake and Flood, resultant Damage from Faulty Workmanship

and Materials, errors in design, plans or speciﬁ cations.

Offsite Storage

Limit $

Transit

Limit $

Waiver of Subrogation (if made in writing prior to loss) is permitted without further restriction.

Permission to Occupy is granted without the need to obtain the insurance company’s consent at time of

occupancy.

Contractors and Subcontractors of Every Tier included as Named Insureds

EXCEPTIONS:

Mail Binder and/or Policy to the undersigned at the address shown above:

By:

Title:

2233 112th Avenue NE | Bellevue, WA 98004 | 425.709.3600

4000 Old Seward Hwy., Suite 200 | Anchorage, AK 99503 | 907.562.2225

Builder'S Risk Insurance Binder Request Form