Fix & Flip, Vacancy

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Fix & Flip, Vacancy

This form is designed to gather information regarding vacancy, fix & flip, and builders risk insurance policies. Please provide accurate information to ensure proper coverage.

Full Legal Name Or Entity Name

The full legal name of the person or business to insure.

For policy documents and communication.

Full property address to be insured.

Provide full mailing address including street, property number, city, zip code, and state.

Full Mailing Address

Provide your full mailing address including street, property number, city, zip code, and state.

Effective Date

Please select the effective date for when you need the policy to start.

Term

Description:
Refunds are based on the carrier’s Minimum Retained Premium (MEP) rules: If you cancel early, the carrier will keep at least the minimum amount they require (varies by carrier), even if the policy was active for only a short time. Choose the shortest term you realistically need to avoid losing money.

3 Months

6 Months

12 Months

Something else

Clear selection

Entity Type

Select the type of entity that is purchasing the policy.

Individual – A single person purchasing the policy.

Joint Venture – Two or more parties joining for a specific project or property investment.

Partnership – Two or more people operating together as co-owners for profit.

Other – Entity type not listed.

Organization – A structured group, such as a non-profit or association.

Estate – Legal entity for managing assets after a person’s death.

Clear selection

I have read and understand the refund terms above. I understand that if I cancel my policy early, I may not receive a refund or may receive only a partial refund based on carrier rules. *

Yes

Include General Liability Coverage?

Covers you if someone gets hurt on the property or if you’re found legally responsible for property damage. Example: someone slips and falls on the vacant property and sues.

Yes

Clear selection

Include Mine Subsidence Coverage?

Protects against damage to the building caused by the ground shifting or sinking due to old, abandoned coal or other mines collapsing underneath. Important in some states with mining history.

Yes

Clear selection

Include Terrorism Coverage?

Covers property damage or losses caused by certified acts of terrorism (as defined by federal law). Without this, terrorist acts are usually excluded.

Yes

Clear selection

Include Limited Theft Coverage?

Limited theft coverage protects against stolen building materials or fixtures that are permanently attached to the property (like installed cabinets, plumbing, or HVAC). It doesn’t cover tools or loose materials and usually requires proof of forced entry.

Yes

Clear selection

Construction type

Please select the type of construction.

Frame – Exterior walls made of wood or other combustible material (may have brick veneer).

Joisted Masonry – Masonry (brick, block, stone) exterior walls with wood floors and roof.

Non-Combustible – Walls, floors, and roof made of metal, concrete, or other non-combustible materials.

Masonry Non-Combustible – Masonry exterior walls with metal or concrete floors and roof.

Modified Fire-Resistive – Walls, floors, and roof have 1–2 hours of fire resistance.

Fire-Resistive – Walls, floors, and roof have 2+ hours of fire resistance (reinforced concrete or protected steel).

Other:

Clear selection

Deductible - the higher the deductible- the lower your cost

$500

$1,000

$2,500

Clear selection

Coverage Type

Help text (show under the question):
Choose Vacant Dwelling if it’s between tenants/for sale and no work is being done.
Choose Renovations (Owner) for cosmetic to moderate remodels (kitchen/bath, flooring, roof, windows, HVAC) when the owner buys the policy.
Choose Renovations (Contractor) when the GC is purchasing the policy for a client project (owner will be listed as additional interest).
Choose Builders Risk for ground-up construction, additions, or any project altering load-bearing structure.

Vacant Dwelling — Property is empty; between tenants/for sale and no work is being done.

Vacant Dwelling Renovations (Owner) — Cosmetic to moderate remodels (kitchen/bath, flooring, roof, windows, HVAC)

Vacant Dwelling Renovations (Contractor) — Property is being renovated & GC is purchasing the policy for a client project (owner will be listed as additional interest).

Builders Risk – Dwelling (Major Renovations) — Ground-up construction, additions, or any project altering load-bearing structure.

Not Sure

Clear selection

Primary risk state (If your headquarters is located outside of Utah)

Skip if non-applicable

Has the applicant incurred any losses/ Claims on the property in the last 3 years?

If yes; Please explain (Skip if non applicable)

Has the applicant had a foreclosure, repossession, or bankruptcy during the past 5 years?

If yes; Please explain (Skip if non applicable)

Has the applicant been indicted or convicted of fraud-related crimes?

During the past 5 years, has the applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson, or any other arson-related crime? If yes; Please explain (Skip if non applicable)

Is any dwelling constructed of logs?

Yes

Clear selection

Is any dwelling constructed on stilts?

Yes

Clear selection

Are any buildings listed on a historical register?

Yes

Clear selection

Are all buildings locked/secured to prevent unauthorized entry?

(Essential to get coverage)

Yes

Clear selection

Is there any body of water or pool on the premises?

Is there a pond, lake, pool, or hot tub on the premises? If yes; Please explain (Skip if non applicable)

Are there any nuisance hazards on the property?

Are there any nuisance hazards on the property (swing sets, vehicles, debris, trampoline, fuel tanks, underground tanks, etc.)?

Yes

Clear selection

Is any lot size more than 5 acres?

If yes; Please explain (Skip if non applicable)

Prior Carrier & Policy Number (Skip if non applicable)

Prior Carrier Limits, Deductible, & Total Premium (Skip if non applicable)

Any claims in the last 3 years?

(On property to be insured, skip if non-applicable) If yes please expalin.

Building description

Please provide a brief description of the building.

Describe the neighborhood

Please select the option that best describes the neighborhood.

Excellent

Good

Fair

Poor

Clear selection

Describe the building condition

Please select the option that best describes the building's condition.

Excellent

Good

Fair

Poor

Clear selection

Date vacated

Please select the date when the property was vacated or last used.

Prior use of building when occupied

Please select the prior use of the building.

Rental

Primary Residence

Secondary Residence

Vacant

Other:

Clear selection

Intended disposition of risk

Please select how you intend to dispose of the risk associated with the property.

Sell

Rent

Other

Clear selection

Does someone check on the property on a regular basis?

Please select one option.

Yes

Clear selection

If yes, how often?

Please select how often the property is checked on.

Daily

Weekly

Monthly

Other

Clear selection

If yes, by whom?

Please select who checks on the property.

Owner

Property Manager

Family/Friend

Other

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Purchase price

Please enter the purchase price of the property.

Total estimated amount that will be spent for improvements

Year built

Please enter the year the building was constructed.

Square feet

Please enter the total square footage of the building.

Stories

Please enter the number of stories in the building.

Was the property inherited?

Please select one option.

Yes

Clear selection

Is the dwelling equipped with functioning circuit breakers?

Yes

Clear selection

Is heat maintained or are pipes drained?

Yes

Clear selection

Is the dwelling is a mobile/manufactured home please select options bellow.

If yes check options bellow (other wise skip)

Dwelling is Anchored

Dwelling is skirted

Date purchased

Please select the date on which the property was purchased.

YYYY

Will anyone other than the applicant be doing the renovations?

If renovations are planned, will anyone other than the applicant be doing any of the work? If yes; Please explain (Skip if non applicable)

Planned renovations

Please select all that apply for planned renovations.

Replace Bathroom Fixtures

Replace Kitchen Cabinets

Replace Heating/Plumbing/Electrical

Replace Roof

Replace Flooring

Interior Painting

Replace Windows

Replace Exterior Doors

Exterior Siding or Painting

Gutting the Premises

Other

By providing this information, you confirm that it is accurate and up to date. Mariah Insurance Agency is not responsible for errors, outdated details, or delays caused by incorrect or incomplete information submitted by the insured. It is the insured’s responsibility to verify all mortgagee and loan details with their lender prior to submission. *

Yes

Type *

Please select one option that best describes the party concerned with the mortgage/ loan.

Mortgagee – Your lender or bank holding the mortgage.

Loss Payee – A person or company that should receive claim payments in case of loss (often for financed property like vehicles or equipment).

Additional Insured – A person or company you want added to the policy for shared liability protection.

Other – Any other interested party.

None

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