Today's Date *

MM

DD

YYYY

Submitted By *

First Name

Last Name

Prolog *

Yes - Prolog Job (=105 Series to be assigned)

No - Not a Prolog Job

Undetermined

CCIP *

Yes

No

Terms *

Lump Sum

Cost Plus Fixed Fee

Cost Plus % Fee

Cost Plus Fixed Fee with Guar. Maximum

Cost Plus % Fee with Guar. Maximum

Other

Job Number Category *

100 (Misc. Small Projects - Cost Plus)

101 (Frontier - Cost Plus - Reimbursable)

102 (Condo Projects)

103 (Erickson Realty - Cost Plus - Reimbursable)

104 (HCC Projects)

105 (Prolog Projects - Cost Plus & Lump Sum - $300k guideline amount)

108 (Individual Stand-Alone - Small Lump Sum)

109 (Frontier - Lump Sum)

Undetermined

Jobsite Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Owner Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Owner Phone Number

(###)

###

####

Owner Contact Person

First Name

Last Name

Owner Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Owner Billing Phone

(###)

###

####

Architect Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Architect Phone Number

(###)

###

####

Project Type *

(Select all that apply)

Commercial

Residential

Non-CCIP

CCIP G/L Wrap

CCIP G/L & W/C

PL/PD Rate *

(Check all that apply)

Core Ins. Rate @ 1%

CCIP Insurance @ 1.5%

CCIP Residential TI @ 1.564%

CCIP Multi-Residential TI @ 1.8%

Other Contract Ins. Rate (describe below)

Additional Information *

(check all that apply)

Schedule of Values

Retention Held - 5%

Retention - NONE Held

Retention Held - 10% (special conditions)

None

BOLI *

Yes

No

Builders Risk *

HCC

Owner

TBD

Project Manager *

First Name

Last Name

Project Manager Phone Number *

(###)

###

####

Superintendent

First Name

Last Name

Superintendent Phone Number

(###)

###

####

Statup Kit *

Yes

No

Preconstruction Start Date

MM

DD

YYYY

Project Start Date *

MM

DD

YYYY

Project Completion Date *

MM

DD

YYYY