Seafirst Insurance Brokers - Offices in Sidney, Salt Spring Island, Brentwood Bay, Saanichton & Oak Bay, BC
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CHBA COC APPLICATION

CLIENT INFORMATION
Name:    
Mailing Address:    
City: Province:
Country: Postal:
Phone: Website:
Fax: E-mail:
PROJECT INFORMATION
Project Name: Project # if applicable
Address:
City:
Province: Postal Code:
Type of Project:

Other

if Other Describe:
RISK INFORMATION
Project
Start Date of Foundation:
Completion Date:
Hard Cost:
Soft Cost:
Total Sum Insured:
Construction
Stories: Area: 2 2
Walls Siding Floors Roof Foundation
Wood Wood Wood Wood Concrete
Non Combustible Brick Non Combustible Asphalt Other
Other Other Other T & G  
      Other  
Fire Protection      
Hydrants:
Fire hall:
Security Guard: None 24 hours While Not Working Other

Exposures: Distance and type of building in feet.
Clear All Sides  
Left of Insured ft.
Right of Insured ft.
Behind Insured ft.
Loss Payees & Additional Insured's:
Name:

 
 

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Offices In
SIDNEY • SALT SPRING ISLAND • BRENTWOOD BAY • SAANICHTON • OAK BAY