Course of Construction Quote

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Quick Quote

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Named Insured *

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Last

Contractor's License # *

Owner's name *

Contact's name *

Phone Number *

Cell Number *

Email *

Mailing Address *

Physical Address / Premise Address *

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City

State

Zip Code

Country

Business Entity *

Sole proprietorship Partnership Corporation LLC

Other *

Construction Details

Construction Location/Address: *

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City

State

Zip Code

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Construction Type: *

Project Cost/Amount *

Intended Occupancy? *

Other *

Estimated Length of Job *

Total Area (sq ft) *

Description of work to be done *

Additional information *

Name of General Contractor (if different) *

License Number *

Contact Name *

First

Last

Phone Number *

Will the insured be the owner/occupant? *

Will the construction site be fenced? *

Will the construction site be lit? *

Has the brush been cleared (if applicable)? *

Is this a mid-term project? *

If so, what percentage has been completed? *

Does the insured plan to sell part or all of the completed project? *

Is this a Rehab/Renovation? *

If yes, what is the value of the existing structure? *

What is the value of the work to be completed? *

Describe the renovation *

Estimated length of the job? *

Which security measures are in use? *

Other *

Has the insured had any claims or losses during the last five years? *

If yes, provide details *

Property Mortgagee/Loss Payee Information:

Name of bank or lending institution *

Address *

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State

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Is the above to be named *

Additional information *

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CSIS Insurance Services, Inc.
CA License #: 0D80851
3315 Old Conejo Road
Thousand Oaks, CA 91320
(888) 501-2747
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