Owners and Contractors Protective Liability Questionnaire
*If the request requires immediate action please contact our staff by phone so we can support you in the timeframe you require.  866-957-KMRD (5673)
KMRD Client Information:
Named Insured / Owner Information:
Contractor / Construction Manager Information:
Description of Covered Project:
0/250 characters
Check if Applicable. Yes Answers Require Explanation Below:
 Check If Applicable and Explain Below
Storing of Inflammable Gases, Liquids, and Explosives
Hazardous Waste Removal or Installation
Surrounding Property Damage Exposure
At, On, or Near a Landfill Site
Synthetic Stucco
Bridge or Overpass Work
Asbestos, Mold, or Lead Abatement
Dam, Reservoir, Jetty, Breakwaters, Piers, Docks, or Wharfs
Surrounding Property Damage Exposure
Potential Third Party Bodily Injury Exposure
Special Jobsite Safety Precautions
0/500 words
Information Outlined in Job Specs: *
 Information Outlined in Job Specs
a. Proposed Starting Date
b. Job Term in Calendar Days
c. Estimated Completion Date
 Type of SubcontractorsPercent of Subcontracted (%)
For the following questions, please read these instructions carefully.
For each section you can either enter each of the requested items OR attach documents or contracts that you may have pertaining to each of the requested information.  Please do not attach the same document or contract twice.  One upload will be sufficient for KMRD Partners, Inc. to find all the necessary information for you.

Limits of Coverage:
Details of Hold Harmless Agreements:
Additional Insureds:
Additional Insured #1
Additional Insured #2
Thank you for utilizing this system. You should recieve confirmation of your request via email.  A KMRD representative will reach out to you with questions if we have them.  If you do not hear from us, feel free to call at 866-957-KMRD (5673)  or contactus@kmrdpartners.com
This form is for communication purposes only.  This form does not bind coverage.