Builders Risk Insurance Quote

Complete the form below so we can prepare an accurate, competitive builders risk quote for your construction or remodeling project.

1Applicant Information

First Name*

Last Name*

Date of Birth*

Driver's License #*

License State*

Phone*

Email*

Preferred Contact*

Marital Status*

Street Address*

City*

State*

ZIP Code*

Co-Applicant's Information(if applicable)

First Name

Last Name

Date of Birth

Driver's License #

License State

Phone

2Builder / Contractor Information

Name*

Years of Experience

Structures Built (last 12 months)

Projected Structures (next 12 months)

Loss History

3Property Information

Address (including county)*

County

Type of Property*

Fire Protection Class

Square Footage*

Number of Stories

Policy Type

Policy Effective Date

4Project Information

Total Completed Value (Excluding Cost of Land)*

Type of Construction Material

Description of Construction / Installation Project*

Additional Interest

Anticipated Completion Date*

Optional Additional Coverage Needs, If Required

Is this a remodeling project?

5Additional Information & Consent

Anything else we should know?

Upload Documents (Optional)

Upload your current declaration page, policy documents, or any other relevant files. You can also take a photo directly from your phone.

Accepted: Images (JPG, PNG), PDF, Word docs. On mobile you can take a photo directly.

I certify that the information provided is accurate and complete to the best of my knowledge.

I agree to be contacted by Lieck Insurance Agency regarding this quote.