Wrap-Up Application for Insurance

/ Arch / Specialty Insurance Agency, Inc.
a member of Arch Insurance Group

Wrap-Up Application For Insurance

1. GENERAL INFORMATION:

Named Insured(s):
Mailing Address:
Project Named & Address:
Project Start Date:
Project Completion Date:
Has The Financing Been Secured?
What Is The Source Of Financing?
Name of Audit Contact, mailing address & phone number:
Name of Loss Control Contact, mailing address & phone number:
Name of Administrative Contact, mailing address & phone number:

1. PROJECT DETAILS:

Describe the project & the surrounding exposures (provide site maps where possible) :
Describe the area/topography & exposure to hillsides;
Has the land been developed, if so provide details including who developed it:
Estimated payroll (all contractors including subcontractors) for project term:
Estimated construction costs for project term:
Construction Cost definition: The total cot of all work let or sublet in connection with each specific project including (1) the cost of all labor, materials and equipment furnished, used or delivered for use in the execution of the work; and (2) all fees, bonuses or commissions made, paid or due.
Estimated total sale prices for all units:

Provide the type of construction projected:

# of Units

/

# of Buildings

/

# of Stories

/

Construction Type

Single Family Dwellings:
Townhouses:
Condominiums:
Apartments:
Other:

If Other is applicable, please describe:

1. BACKGROUND/EXPERIENCE OF SPONSOR/PROJECT MANAGER/GENERAL CONTRACTOR:

Describe the past Wrap-Up experience/expertise of the Sponsor and Project Mgr./GC.:
Name of General Contractor, name of contact, mailing address, phone number, and experience of General Contractor For Wrap-Up:
Provide Loss History for Past Wrap-Ups (attach currently valued company’s loss runs):
For the GC, provide 7 years of loss history (attach currently valued company’s loss runs):

A. Pre-Construction Operations

1. Does the Named Insured conduct Environmental Impact studies on job locations prior to building? Yes No
2. Does the Named Insured purchase land for building that is undeveloped? Yes No

3.When the Named Insured purchases land for building, is it generally partially or completely developed?

1. To what extent is the land developed by the Named Insured?

b.If the Named Insured purchases undeveloped land that is not leveled, identify whom they normally hire to do such leveling:

c. How does the Named Insured assess how the work was performed?

d.If the developed land includes drainage systems, does the Named Insured identify whether drainage testing was performed? Yes No

B. Quality Control Program

1. Does the Named Insured have a Quality Control Program in effect to monitor all construction activities?

Yes No If yes:

a.When was the program implemented?

b. When was the program last revised?

c.Who is responsible for managing the program?

d.Briefly describe the program and/or attach a copy of the program to this questionnaire:

1. Does the Named Insured have a written procedure requiring that videos and/or photos be taken of the construction job? Yes No

1. If yes, please attach underwriting information. Such information should include a log of procedures, benchmarks or progress from inception to completion and retention/archiving practices.

3.Does the Named Insured have a written Site Inspection Program? Yes No If yes:

1. When was this program established?

b.When are the inspections performed?

c.Who determines the inspection schedule?

d.Describe the established criteria for required follow-up:

e.Explain if surprise inspections are conducted:

4.Does the Named Insured have any Independent Inspections/Assessments performed? Yes No

1. If yes, provide a brief description of these services:

1. Does the Named Insured generate project or home specific reports during the time of construction?

Yes No If yes:

1. Briefly describe the types of reports generated:

b.Who generates these reports?

c.Who monitors these reports?

1. Are there established procedures for handling these reports, including follow-up procedures on identified issues? Please explain.

6. Does the Named Insured have an established program for Trade Partner training? Yes No

a.If yes, when does the training take place?

b.If yes, does the program stipulate that there be periodic updates for any planned project wide changes.

Yes No

7. Does the Named Insured have an approved list of vendor material to be used in construction projects? Yes No

8. Does the Named Insured centrally purchase materials? Yes No

C. Safety Program

1. Does the Named Insured have a written safety program? Yes No If yes:

a. Who is designated as the safety manager on site for each project?

(1)Is the designated person on site full time? Yes No

b. Does the program require that there be scaffolding and fall protection? Yes No

(1)What height requirement is maintained?

c. Does the Named Insured have access control for customers and future customers on job sites? Yes No

d. Does the Named Insured have a drug free policy in place? Yes No

e. Does the Named Insured have any safety incentive programs? Yes No

(1) If yes, provide a brief description:

1. Does the safety manual specifically address:

a. Site Security? / Yes No Not Applicable
b.Attractive Nuisance? / Yes No Not Applicable
c.Power Lines? / Yes No Not Applicable
d.Traffic Control? / Yes No Not Applicable
e.Utility Identification? / Yes No Not Applicable

E. Sub-contractors

1. Provide a separate attachment (if necessary) for Estimated Payroll by class:

F. Post Construction Operations

1. Does the Named Insured have a written procedure for conducting final inspections for each dwelling at completion?

Yes No

a.If yes, are these final inspections documented? Yes No

b.If yes, how long is documentation maintained? Yes No

2.Does the Named Insured conduct walk through inspections with the buyers? Yes No

a.If yes, is a checklist used? Yes No

3.Does the Named Insured provide Homeowners Manuals to the buyers? Yes No

4.Does the Named Insure establish Customer Service Liens for all projects? Yes No

5.Does the Named Insured solicit and obtain homeowner surveys? Yes No

a.If yes, explain how the database of the surveys are maintained:

b.If yes, how long are the surveys retained in the database?

G.Home Warranty Program

1. For single-family dwellings, townhouses, and condominiums, are Home Warranty policies provided? Yes No If yes:

a.What is the duration of these policies? Years

b.Are these policies renewable by the dwelling owner? Yes No

1. What is the Named Insured's turn-around time on "fixing" problems under warranty?

d.Who does warranty repairs?

e.Is there a database monitoring system for the Warranty Program? Yes No

If yes, provide a description of the system?

f.Are warranty histories, claims and loss records maintained? Yes No

1. Who is responsible for monitoring the warranty program?

1. Miscellaneous Information that must be attached to this Questionnaire

1. Attach last years audited (if available) financial statement:
2. Attach a copy of Home Warranty Policy.

NOTICE TO APPLICANT, PLEASE READ CAREFULLY:

THE APPLICANT REPRESENTS THAT THE ABOVE STATEMENTS AND FACTS ARE TRUE AND THAT NO MATETIAL FACTS HAVE BEEN SUPPRESSED OR MISSTATED.

COMPLETION OF THIS FORM DOES NOT BIND COVERAGE. APPLICANT’S ACCEPTANCE OF COMPANY’S QUOTATION IS REQUIRED PRIOR TO BINDING COVERAGE AND POLICY ISSUANCE. IT IS AGREED THAT THIS FORM SHALL BE THE BASIS OF THE CONTRACT SHOULD A POLICY BE ISSUED, AND IT WILL BE ATTACHED TO THE POLICY.

APPLICANT HEREBY AUTHORIZES THE RELEASE OF CLAIM INFORMATION FROM ANY PRIOR INSURER TO THE COMPANY INDICATED ABOVE.

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE CONTAINING ANY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT.

Signature of Applicant: / Date:
Name and Title:
Signature of Producer: / Date:
Name and Title:

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