Builder'S Risk Insurance Binder Request Form (Page 2 of 3) in pdf

Builder'S Risk Insurance Binder Request Form Page 2

The following checklist is provided to assist you in reviewing Binders or Coverage Conﬁ rmations for

completeness, accuracy and coverage requirements. This checklist is referenced to a sample Binder of

Coverage form used by our broker, Parker, Smith & Feek. If other than the Parker, Smith & Feek form is

provided, the same checklist items should be covered by whatever form is provided. If you need assistance in

reviewing any Binder or Conﬁ rmation of Coverage form, please call Ed Chapin at Parker, Smith & Feek.

Item No.

CAPTION

COMMENTS

Issue Date

Date the Binder is issued by the Owner’s Agent.

Insured

Owner, Contractor and Subcontractors of Every Tier should

be shown here

Project Description

Self-explanatory

Amount of Insurance

100% Replacement Cost of the project

Term of Policy

Must encompass the full contract term

Coverage

As required by the terms of the contract with owner

Deductibles

Self-explanatory

Cancellation Notice

Number of days notice should not be less than that speciﬁ ed

in the contract or forty-ﬁ ve (45) days if there is no contract

reference

Company and Bests’ Rating

Full name of the insurance company(ies) providing the

coverage should appear here. Best’s Rating should also

appear here

Binder Dates

Binders are only valid for the time period speciﬁ ed. If a

copy of the policy isn’t provided by the Owner by the binder

expiration date, a new Binder should be requested.

Agent’s Name

Owner(s) Agent

Authorized Representative

The binder should be signed by the agent of the Owner for

the insuring company(ies)

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 Page 2