Course of Construction Questionnaire

Auto Change Request Forms

Insured's Information

Insured's Name:
If part of a larger group, i.e. a Diocese, please name your sub-group, parish, etc.:
Insured's Address
Address 1:
Address 2:
P.O. Box/Apt.:
City:
State:
Zip Code:
Your Name:
Your Telephone Number:
Your Email:
Fax Number:
Building Information
Please select one:
New Building
Renovation
Addition To Existing Building
Estimated Start Date:
Estimated Completion Date:
Address of Construction Site
Address 1:
Address 2:
P.O. Box/Apt.:
City:
State:
Zip:
Proposed Occupancy/Type of Building (ex: Dwelling, Church, Hall, Kitchen,etc.):
Project Name/Description:
Construction Type
Please indicate percentage; indicate '0' if not applicable or unknown.
Frame %	Joisted Masonry %
Noncombustible/Metal %	Masonry Noncombustible %
Modified Fire Resistive %	Fire Resistive %
Other %
If "Other", please describe:
Estimated building value upon completion:
Building	Contents
For a New Building
Square Footage:
Number of Stories:
If this project is a Renovation or Addition:
Additional Square Footage:
Additional Number of Stories:
Contractor Information
Contractor's Name:
Contractor's Address
Address 1:
Address 2:
P.O. Box/Apt.:
City:
State:
Zip:
Contractor's Telephone Number:
Additional Notes:
Enter Security Code as shown below: