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Builders Risk Quote Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

How did you hear about us?
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Company Information
Company Name
Required
First Name
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Last Name
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Street
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City
Required
State
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ZIP / Postal Code
Required
E-Mail Address
Required
Primary Phone Number
Required
Business Type
Required
Description of Named Insured
Required
Is the Builder's Name Different than the Named Insured?
Required
If "yes" provide builder's name
Optional
Does Builder/Remodeler/Owner/GC Have at Least 2 Years of Experience?
Required
Number of Structures Built/Remodeled During the Past 12 Months
Required
Number of Structures Projected for the Next 12 Months
Required
Has the Builder/Remodeler and/or Structure had any Single Loss over $10,000 in the last 3 Years (Include insured/uninsured losses)
Required
Property State
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Property County
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Type of Project
Required
Type of Property
Required
Policy Effective Date
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/ /
Property Address Line 1
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Property Address Line 2
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Property City
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Property County
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Construction Material
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Number of Stories
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Intended Occupancy
Required
Will Structure Be Occupied During Construction?
Required
Square Footage INCLUDES Basement
Required
Has the Project Started? If "Yes", Date Started and Percent Complete
Required
Expected Completion Date of Project
Required
/ /
Is there a Sales Contract on this Structure?
Required
Base Coverages
Coverage Description
Total Completed Value of any one Structure
Required
Limit
Required
Total Completed Value of All Covered Property
Required
Limit and Deductible
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Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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Please note that we cannot bind insurance via email, fax, or phone. Any quotes given are subject to underwriting guidelines by the respective insurance carriers. Any reference of coverage used are not intended to express legal opinion as to the nature of coverage, but rather just a brief generalization of coverages. Please read your policy for specific details of coverages.
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ECI Agency, Inc. | 325 Piedmont Rd N | Piedmont, OK 73078 | Ph: (405) 373-2977  M-F 8am-5pm Powered by Insurance Website Builder