Builder's Risk Questionnaire

KMRD Client Contact Information:

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Project Description:


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General Contractor's Address:
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Job Location Address:

Value and Insurance Limits:

Other General Information:

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Type of Fire Department:
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If yes, please complete the Loss Addendum (attached at end of questionnaire) for each loss over the past 3 years.

Additional Named Insured Requirements

Mortgagee (if required)

Renovations Project Supplemental Questions & Risk Considerations

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If yes, please complete the following questions:
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Thank you for utilizing this system. You should receive 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.