V. Project information Has the project started? Yes No If date started: (MM/DD/YYYY) “Yes”, Percent complete: % Will renovations begin within 60 days of the policy effective date? Yes No Is there a sales contract on this structure? Yes No Estimated length of project (in months): New Construction project only: Is the structure modular? Yes No If must fill out Additional Section IX on page 4 “Yes”, Remodelling project only: Scope of work Remodel Remodel/Minor Structural Restructuring Description of work to be performed: Restructuring project only: Have architectural plans been developed for this project? Yes No Has a licensed engineer reviewed & approved the plans? Yes No Please provide the name of the engineer or engineering firm that approved the project: VI. Coverage information Base Coverages Coverage description Limit Deductible Total completed value of any one structure $ Greater than $4,000,000 will require underwriter approval Total completed value of all covered property New $ $ Constr. Greater than $4,000,000 will require underwriter approval Amount of renovation/improvements [1] $ Greater than $4,000,000 will require underwriter approval Existing building(s) or structure(s) amount (if existing structure is insured) [2] $ Actual Cash Value but not more than Market Value Total completed value of all covered property [1] + [2] $ $ Remodelling Greater than $4,000,000 will require underwriter approval Additional Coverages Increased limit Coverage description Default limit * (New Construction only) Back-up or overflow of sewer, drains or sumps $5,000 Debris removal $20,000 Fire department service charge $10,000 Pollution clean up and removal $15,000 Reward $10,000 Scaffolding, construction forms and temporary structures $20,000 Scaffolding re-erection $10,000 Property at a temporary storage location $10,000 / 2.5% Property in transit $25,000 / 5% Valuable papers and records $20,000 *Cannot increase default limits for remodellers
V. Project information Has the project started? Yes No If “Yes”, date started: (MM/DD/YYYY) Percent complete: % Will renovations begin within 60 days of the policy effective date? Yes No Is there a sales contract on this structure? Yes No Estimated length of project (in months): New Construction project only: Is the structure modular? Yes No If “Yes”, must fill out Additional Section IX on page 4 Remodelling project only: Scope of work Remodel Remodel/Minor Structural Restructuring Description of work to be performed: Restructuring project only: Have architectural plans been developed for this project? Yes No Has a licensed engineer reviewed & approved the plans? Yes No Please provide the name of the engineer or engineering firm that approved the project: VI. Coverage information Base Coverages Coverage description Limit Deductible New Constr. Total completed value of any one structure Greater than $4,000,000 will require underwriter approval $ Total completed value of all covered property Greater than $4,000,000 will require underwriter approval $ $ Remodelling Amount of renovation/improvements [1] Greater than $4,000,000 will require underwriter approval $ Existing building(s) or structure(s) amount (if existing structure is insured) [2] Actual Cash Value but not more than Market Value $ Total completed value of all covered property [1] + [2] Greater than $4,000,000 will require underwriter approval $ $ Additional Coverages Coverage description Default limit * Increased limit (New Construction only) Back-up or overflow of sewer, drains or sumps $5,000 Debris removal $20,000 Fire department service charge $10,000 Pollution clean up and removal $15,000 Reward $10,000 Scaffolding, construction forms and temporary structures $20,000 Scaffolding re-erection $10,000 Property at a temporary storage location $10,000 / 2.5% Property in transit $25,000 / 5% Valuable papers and records $20,000 *Cannot increase default limits for remodellers
APRIL-Canada-COC-and-Wrap-Up-application.docx