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Home My WebLink AboutBuilders Risk AssessmentBuilders Risk - ER072862116_ Page 1 of 4 Builders Risk New Business For assistance call 866-279-8253 Insured name: Theodore Ferguson Issued by: axainsurence Effective date: 01/01/2015 - 01/01/2016 Agency: AXA.INSURANCE AGENCY ................................. Status: Complete Producer code: A0082288 Policy description: One-shotresidentialnew construction +"Aack to oolicv summary i 7 view comments Producer code * A0082288 (Select producer code you want to write business —� under)`_ --------'--------•-'---- E-mail address * karla@axainsuranceagency.com Insured name * Theodore Ferguson ~- — --' Insured country * United States Insured mailing address line 1 * 10851 South Ocean Drive Insured mailing address line 2 Insured city Jensen Beach State FL Zip 34957 - Insured Contact Information Name E-mail address Phone number Fax number __..—..._------------.— ------ ---- ---- Insured's form of business * Individual If 'Other' is selected enter description Description of named Insured * Owner J — Is the builder's name different than the named insured * No If "Yes", provide the builder's name Unknown Does builder/remodeler/owner/GC have at least 2 * Yes yearsexperience If "No", the risk is not eligible Number of structures built/remodeled during the past * 3-50 12 months If "Other", enter the number In the field provided. Number of structures projected for the next 12 * 3-50 months If "Other", enter the number In the field provided. Has the builder/remodeler and/or structure had any * No — single loss over $10,000 In the last 3 years (Include insured/uninsured losses) If "Yes", include the date, description, and amount of each loss below Property country United States Property state * FL --- - ------ - - - - ---- - Property county * ST. LUCIE Type of project* New construction ---- ype of policy * One-shot policy Type of property * Residential If "Commercial", choose coverage form 40471 (web Issued policies) Policy effective date * 01/01/2015 -- (12:01 a.m. Standard Time at Insured's mailing address above.) - ----- ---- - - - - --- Policy period * 1 year Property address line 1 * 10851 S Ocean Dr Property address line 2 Property city * Jensen Beach State FL Zip 34957- Property county ST. LUCIE Will the contractor be Insuring more than one * No _ building on this policy or are there any other buildings insured with Zurich within 100 feet of this structure written on another policy If yes, please provide total estimated completed value of all structures under construction within 100 feet and insured with Zurich, including this one $ If > $5M underwriting approval is required Construction material * 3cisted Masonry - exterior walls constructed of masonry materials such as brick, concrete, block, stone or similar materials and the floors and roof are of wood construction. Protected Protection class * 4 Is this structure located within 1,000 feet of *Yes tidal water or located on a barrier Island Number of stories * 2 If over 7, underwriter approval required Intended occupancy * Single Family Dwelling http://buildersrisk.usassure. com/zis/br/brwebv5-8.nsf/all/F3 786E448BD97B4A8625 7D7... 12/ 16/2014 Builders Risk - ER072862 a 6 Page 2 of 4 Describe actual occupancy Owner Occupied Will structure be occupied during construction * No — If "Yes", by whom -Select- If "Other" enter description Square footage INCLUDES basement * 1,490 Any previous losses at this location as a result * NoW yes, underwriter approval required of quake, flood, wind, fire or vandalism If yes, explain all losses including the peril involved, amount of the loss and the date of the loss Is this a model home * No Has the project started * No If "Yes". date started Percent complete 0% Expected completion date of project * 04/02/2015 Is there a sales contract on this structure * Yes Is the structure modular * No If yes, underwriting approval required, and modular questions will be asked If Insuring multiple buildings (maximum 2 for residential) at one location, please enter the largest single building value under the any one structure limit and the total of all building values under the all covered property limit. Base :overage description Limit Deductible rotal completed value of any one structure $225,000 3reater than $1,500,000 will require underwriter approval. rota) completed value of all covered property n — �— -- — $225,000 $1000 3reater than $1,500,000 will require underwriter approval. you The following additional coverages apply to this policy. Depending on the policy type and coverage, you may increase the limits by enterinq the value Into the limits fieli treinuueiers ano reporting turn pouaes noc engiuie tor increase). An increase in emir win resuir in an increase in premium. You may return to the default limit by clicking i the "Reset to default" button. Coverage description Limit Debris removal $20,000 Fire department service charge $10,000 Ordinance or law — — Loss to the undamaged portion of the building — Y Included Demolition cost $1,000,000 Increased cost of construction $1,000,000 Combined aggregate for demolition cost and Increased cost of construction $1,000,000 Pollution clean up and removal A--J �—�_---�— $15,000 — Reward $10,000 Scaffolding, construction forms and temporary structures $20,000 Scaffolding re -erection $10,000 Property at a temporary storage location u $10,000 Property In transit $25,000 Valuable papers and records $20,000 The following optional coverages are available by endorsement for an additional premium charge. E Coverage description Limit Deductible Better green endorsement $0 $1,000 Building rating Expediting expense $0 $1,000 Change order endorsement $1,000 Include the change order endorsement * No http://buildersrisk.usassure. comlzislbrlbrwebv5-8.nsfIallIF3 786E448BD97B4A86257D 7... 12/ 16/2014 Builders Risk - ER0728621 6 - Page 3 of 4 i Coverage description Limit Deductible Development/subdivision fences, walls or signs $0 $1,000 _$Flat Earthquake $0 Deductible Earthquake zone * Zone 4 OR What is the building shape * % Values at Risk If 'Other' $10,000 Minimum Include coverage on the structure's exterior walls with more than 10% of masonry veneer Flood —•— $0 $ Flat Deductible Flood zone OR Basement * o/o Values at Risk Does this project consist of multiple buildings * $10,000 Minimum How many buildings are In this project If this risk is held underwriting will be requesting the following information with respects to projects Involving multiple buildings: ■ Number of buildings In the project ■ Number ofstories per building ■ Value of each building ■ Square footage of each building ■ Start and completion date of each building a Will permanent coverage be placed on each building as it is completed? * Distance between each building (provide a plot plan) Testing Coverage for Building Systems $1,000 Add testing coverage for building systems coverage * No Soft costs $0 14 days Soft costs Include: _ ■ Advertising & promotion expense ■ Interests on Construction Loan ■ Architect, Engineer & Consultant Fees ■ Real estate & Property Tax Assessments ■ Commissions or fees for renegotiation of leases ® Insurance Premiums e Legal and Accounting Fees n Fees for Licenses & Permits" Wind coverage _ Do you want to exclude wind coverage * Yes Eligible for the wind pool * - Yes Will wind coverage be purchased through the wind Yes pool What limit can be purchased * $200000 Wind deductible option * Wind deductible percentage Named storm deductible * This screen shows the list of additional interests associated with the policy. You can add, edit or delete additional Interests from here. L.UfIC11L ILC1119 Columns headers that are underlined can be sorted by clicking on the column header. Name Address City State/Province Postal Code Phone 11M Effective Date Status There are currently no additional Interests. When you click on the'lssue Policy' button, a policy number will be generated, and the policy dec and various forms will be pre -filled. Clicking the 'Previous' button may require that the risk be sent to underwriter approval again. You can view the entire application by clicking here. Please Note: This quote if Issued will be invoiced on a direct bill basis. Upon issuance, US Assure will process a premium invoice for this policy within 24-48 hours and mall It to the address listed on the policy. Should you have questions about our billing process, contact us at (800) 800 - 3907, option 2. Base coverages Limit Rate Premium Total completed value of any one structure $225,000 Total completed value of all covered property $225,000 $0.26 $585.00 $1,000 deductible applicable to losses to covered property http://buildersrisk.usassure. comlzislbrlbrwebv5-8.nsflaM3 786E448BD97B4A8625 7D7... 12/ 16/2014 -Builders Risk - ER07286216 Page 4 of 4 Base coverages Limit Rate Premium Additional coverages Limit Rate Premium Debris removal $20,000 $0.00 $0.00 Fire department service charge $10,000 $0.00 $0.00 Ordinance or Law Loss to the undamaged portion of the building Included Demolition cost $1,000,000 Increased cost of construction' v $1,000,000 Combined Aggregate for Demolition Cost and lncreased Cost of Construction _ $1,000,000 $0.00 $0.00 Pollution clean up and removal �— _ — -- $15,000 $0.00 $0.00 Reward — '—` ` �— �~ _.—..___---_----_— $10,000 $0.00 $0.00 —�— Scaffolding re -erection Scaffolding, construction forms and temporary structures _ --� -- Property at a temporary storage location —~ V ~ — — �^ `— Property in transit w v ' � $10,000 $20,000 — — $10,000 $25,000 $0.00 $0.00 $0.00 $0.00 — $0.00 _ $0.00 $0.00 �$0.00 Valuable papers and records $20,000 $0.00 $0.00 Optional coverages Wind exclusion Totals and surcharges Premium all coverages Commission amount (15.00%) 2012 FIGA Regular Assessment: 0.14% Total policy premium Limit Rate Premium nja^ n/a Premium $585.00 Please Note: This policy is direct bill. Upon Issuance, US Assure will Invoice the policyholder directly based on the terms outlined below. Direct Bill Payment Plan 100% Down, 0 Additional Payments ($585.82) Prior to binding coverage with Zurich, you (the agent) will need to provide the customer with a printed copy of the attached disclosure notice terms required by the Terrorism Risk Insurance Act of 2002 or verbally advise the customer of the attached disclosure notice terms. If you want to learn more about the compensation Zurich pays agents and brokers visit: htto://www.zurfchnai3roducercompensation.com or call the following toll free number: (866) 903-1192. This Notice of Disclosure is provided on behalf of Zurich American Insurance Company and its underwriting subsidiaries. Any person who knowingly and with intent to Injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. The undersigned is an authorize wd re resentativ of the applicant and certifies that reasonable enquiry has been made to obtain the answers to questions on this application. He/She certifies that the ansa rue, co ect and complete to the best of his/her knowledge. Insured's Sign ture Agent's Signature: 1t1� Date: I Date: o f I —"� 1 The following important messages pertain to your policy. THIS IS NOT A QUOTE: Clicking on the "Next" button will issue the policy. If you would like to cancel this transaction please click on the "Cancel Transaction" button. Copyright 2001-2014 by US Assure I Terms of Use. I Privacy Notice (Builders Risk Web US v5.810SWEB0IA) http://buildersrisk.usassure.com/zis/br/brwebv5-8'.nsfIallIF3786E448BD97B4A86257D7... 12/16/2014