Quick Indication* Application

Please complete the application below to request a General Liability and Builder's Risk premium indication from the RWC Insurance Advantage.
Business Name
Physical Address
Mailing Address
City
State
County
Zip Code
Business Phone Number
Cell Phone Number
Fax Number
Email
Contact Name
Best Time to Contact
General Liability
Expiration Date
Current General Liability Carrier
Builder's Risk
Expiration Date
Current Builder's Risk Carrier
How many homes do you plan to build next year?
How many of those homes will be multi-family?
Will any of your buildings be more than:
1000 ft. from a fireplug?
Yes
No
2 miles from a fire station?
Yes
 No
Does your work include any non-residential construction?
Yes
 No
Average sale price per home $
How many Executive
Supervisors do you employ?
Average construction cost per home excluding land & profit? $
What % of your work is strictly
residential remodeling, if any?
%
Est. annual employees payroll excluding officers & clerical $
List the Counties in which you plan to build
How did you hear about us?
Questions or Comments:
*Information provided will give an indication of pricing. All pricing subject to full application and program requirements if coverage is bound.
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