Course of construction insurance Success | Toronto Insurance Solutions

New Build - Residential Projects (up to 6plex in size)
Consent*
I agree to the privacy policy.
PLEASE READ BEFORE: A claim will become invalid and the Insured’s right of recovery is forfeited where (a) an Applicant for this contract gives false particulars to the prejudice of the insurer or knowingly misrepresents or fails to disclose any fact in any part of this application required to be stated therein; or (b) the insured fails to inform material changes to these facts during the term of the contract; (c) the insured contravenes a term of the contract or commits a fraud; or (d) the insured willfully makes a false statement in respect of a claim. The Applicants have reviewed all parts and attachments of this application and acknowledge that all information is true and correct and understand that this application for insurance is based on the truth and completeness of this information. The personal information provided in this document and in the future, including, but not limited to, credit information and claims history may be collected, used and disclosed by the insured’s representative or insurance company, subject to local legislation, for the purpose of communicating with the insured or their representative, assessing the application for insurance and underwriting any such policies, evaluating claims, detecting and preventing fraud, and analyzing business results. I confirm that all individuals whose personal information is contained in this document have authorized that I agree to the above on their behalf.

Applicant’ #1 Name*
First Last
Date(s) of Birth:Applicant #1*
MM slash DD slash YYYY
Applicant #2 Name
First Last
Date(s) of Birth:Applicant #2
MM slash DD slash YYYY
Email*
Phone*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Have you ever had any prior losses (claimed or not) under a construction policy?*
If YES, Please describe:
Have you ever had insurance refused or cancelled?*
If YES, Please explain:

Do you Have a Mortgage?*
If Yes Mortgagee Company Name
Address for Mortgagee Company
Street Address City State / Province / Region ZIP / Postal Code

PROJECT Start Date:*
MM slash DD slash YYYY
PROJECT Completion Date:*
MM slash DD slash YYYY
Description of Project:*
Project Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Square footage of the finished area:*
Square footage of the unfinished area (i.e. unfinished basement):*
Building*
Number of Stories:*
Exterior Walls:*
Siding:*
Floors:*
Roof:*

Distance to Nearest Fire Hydrant*
Distance to fire hall: km*
fire hall:*
Distance to closest occupied area in feet?*
Is project view able from road?*
Is project managed by a professional general contractor?*
If NO, please explain who is managing, and list related prior experience (prior jobs):*
If YES, Name of General Contractor:
Number Years in Bus:
Does General Contractor carry CGL?*
Loss History?
If yes, Please describe:
List of similar projects in past 5 years:

Rebuild Costs (Cost to Rebuild: Labour and Materials) $*
Soft Cost: (Optional by endorsement – eg. Finance Costs, Legal, Accounting, Other Carrying Cost) $*
Distance from nearest body of water: KM*
Height above body of water:

PLEASE READ - Complete the following if project already commenced
On what date did the municipality issue the building permit?
MM slash DD slash YYYY
What date did framing for the foundations start?
MM slash DD slash YYYY
Why was insurance not placed at the time construction started?
Have there been any incidences on the site that could result in a loss?
If Yes Please explain:
Are there any builder liens on this property?
if Yes Please explain:
Any changes in the financial status of the contractor or site owner?
if Yes Please explain:
What percentage of construction budget has been spent as at today?
Nature of work that remains:
NOTE: Insurance is not in effect until Broker has issued a binder or policy documents.
Signature of Applicant(s): Please Enter Your Name*

Success!

If you are doing renovations or additions:

If you are building a new home, there are 2 options to complete the form:

BUILDERS RISK APPLICATION

Step 1 of 8

New Build - Residential Projects (up to 6plex in size)

PLEASE READ - Complete the following if project already commenced

NOTE: Insurance is not in effect until Broker has issued a binder or policy documents.