Builders Risk Questionnaire Enter some basic info below to start the quote process Step 1 of 9 11% Are you a current client of Prominent Insurance ?(Required) Yes, I'm a current client. No, I'm a new client. Your Name (Personal Name of owner)(Required) First Last DATE OF BIRTH OF OWNER(Required) MM slash DD slash YYYY Entity name that owns/will own the property(Required) Business Address ( Mailing Address )(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Federal Identification ( EIN ) Property Location Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How many Residential units on the property?(Required) Single Family Duplex Triplex Fourplex 5 or more units What is intended use of property?(Required) Buy & Hold Fix & Flip Keeping vacant to sell to investor Property Purchase Price(Required)Property Rehab Cost(Required)What effective date do you want for your new insurance?(Required) MM slash DD slash YYYY Has the Renovation Started or will start in the next 60 Days(Required) Yes NO Would You like to add coverage for Earth Movement ( Earthquake & Sinkhole )(Required) Yes NO Any common areas available for use by more than 1 Tenant(Required) Yes No Does the attached parking exceed 2,000 sqft or 24 spaces(Required) Yes No Will there be any structural renovations(Required) Yes No Is the location professionally managed(Required) Yes No Is there a pool, hot tub or spa at this location(Required) Yes No Is the porch or roofline sagging(Required) Yes No Are functioning detectors installed(Required) Yes No Does the property have Knob & tube or aluminum wiring(Required) None Knob & Tube Aluminum Unknown Does the location contain a wood-burning stove(Required) Yes No Are there any detached structures on the property(Required) Yes No Are there any existing city/state housing code violations associated with this property(Required) Yes No Are there any local/state rental law, code or statute violations associated with this property(Required) Yes No Are locks Changed or replaced upon a tenant leaving(Required) Yes No Are there any existing damage or maintenance issues at this property(Required) Yes No Does this Location have a wood shake roof(Required) Yes No When Required are Heating-Electrical and plumbing systems serviced by a qualified trade professional(Required) Yes No Does the proeprty have Exterior Insulating finishing systems (EIFS) on supporting structures(Required) Yes No Is the property on stilts ( not including crawlspaces)(Required) Yes No Does the property have an elevator, lift or hoist on premises(Required) Yes No Has this property had any claims(Required) Yes No Lien Holder information (Lender Information)What else do we need to know to deliver you an outstanding experience? **Important —Please note completion of any request(s) for information does not constitute the purchase of insurance. No coverage may be added, changed or bound as a result of submitting a request for information or quotation of insurance. All coverage must be confirmed by the agency in writing subject to an acceptable signed application meeting the underwriting guidelines of the Insurance Company.