Please fill out the form below and a qualified representative from PCAT will contact you regarding the Builder's Risk Coverage program.

Member Name:
Member Number:

Project Details

Type of Project:	New ConstructionRemodel
Location Address:
City:		State:
County:		Zip:

Structure Details

Will the structure be occupied during construction:	Yes   No	Has the project started:	Yes   No
If No, anticipated start date:		Anticipated Completion date:
If yes, when did it start:		Anticipated Completion date:
Percent complete:		Estimated completion value:
Fire Protection Class:		Number of stories:
Square footage:
Scope of work:
What is the intended use of structure:
Premises Security:

New Construction

For New Construction, please advise the construction of the following:
Exterior Support Walls:		Roof Decking:
Exterior Support Framing:		Floors:
Roof Supports/Trusses:

General Contractor

Name: Address: City: State: Zip:
No. of structures worked during last 12 months:	1-2   3-50    Other:
No. of structures projected for the next 12 months:	1-2   3-50    Other:
Years of Experience:
Limit of Liability Insurance Carried:
Any single loss over $10,000 in the last 5 years?:	Yes   No
If YES, please provide date, description of loss, and amount of each loss below.
Add General Contractor as additional insured?	Yes   No