I. Insured information Insured name Mailing address City Province Postal code Insured’s form of business: Corporation Individual Joint venture LLC Partnership Other: Description of named insured: Owner/Contractor Owner Contractor II. Builder information Does builder/remodeller/owner/GC have at least 2 years experience? Yes No If “No”, the risk is not eligible Is the builder’s name different than the insured? Yes No If would you like to add the builder as an other named insured? Yes No “Yes”, Additional Interests (* 1. Additional Insured – Builder, 2. Additional Insured – Other, 3. Loss Payee, 4. Mortgagee, 5. Premium Finance Company): # Name Address City Province Postal Code Phone Type * Details of last 5 projects, completed in last year 2 years Other: Project Name Description (include construction type, stories, occupancy) Value Has the builder/remodeller had any single loss over $10,000 in the last 3 years (include insured/uninsured losses)? (BuildersRisk claims only) Yes No If include the date, description, and amount of each loss below (attach separate sheet if required): “Yes”, Date (MM/DD/YYYY) Description Amount (including reserves) III. Policy information Type of project Policy period New Construction 1 year from effective date Remodelling/Renovation coverage for the existing structure 6 months from effective date excluding (Remodelling only) Remodelling/Renovation including coverage for the existing structure 9 months from effective date (Remodelling only) If project, must fill out Additional Section X on page 4 “Remodelling/Renovation” Type of property Policy effective date (MM/DD/YYYY) Residential (1-4 Single Family Units) Commercial Personal information is processed by April and its affiliates and service providers, both domestic and foreign. Contact the April Privacy Officer for information on foreign service providers at For the purpose of the Insurance Companies Act (Canada), this document was issued in the course of the Company’s insurance business in Canada.
I. Insured information Insured name Mailing address City Province Postal code Insured’s form of business: Corporation Individual Joint venture LLC Partnership Other: Description of named insured: Owner/Contractor Owner Contractor II. Builder information Does builder/remodeller/owner/GC have at least 2 years experience? Yes No If “No”, the risk is not eligible Is the builder’s name different than the insured? Yes No If “Yes”, would you like to add the builder as an other named insured? Yes No Additional Interests (* 1. Additional Insured – Builder, 2. Additional Insured – Other, 3. Loss Payee, 4. Mortgagee, 5. Premium Finance Company): # Name Address City Province Postal Code Phone Type * Details of last 5 projects, completed in last year 2 years Other: Project Name Description (include construction type, stories, occupancy) Value Has the builder/remodeller had any single loss over $10,000 in the last 3 years (include insured/uninsured losses)? (BuildersRisk claims only) Yes No If “Yes”, include the date, description, and amount of each loss below (attach separate sheet if required): Date (MM/DD/YYYY) Description Amount (including reserves) III. Policy information Type of project New Construction Remodelling/Renovation excluding coverage for the existing structure Remodelling/Renovation including coverage for the existing structure If “Remodelling/Renovation” project, must fill out Additional Section X on page 4 Policy period 1 year from effective date 6 months from effective date (Remodelling only) 9 months from effective date (Remodelling only) Type of property Residential (1-4 Single Family Units) Commercial Policy effective date (MM/DD/YYYY) Personal information is processed by April and its affiliates and service providers, both domestic and foreign. Contact the April Privacy Officer for information on foreign service providers at For the purpose of the Insurance Companies Act (Canada), this document was issued in the course of the Company’s insurance business in Canada.
APRIL-Canada-COC-and-Wrap-Up-application.docx