Submit Assignment
Thank you for contacting us to submit a new project!
If you are here to submit a Building Consulting matter, please note that effective 6/1/23, we have transitioned our Building Consulting services to DBI Consultants. You may continue to submit your assignment details via our web form and all pertinent details will automatically be sent to the DBI team. You may also contact DBI directly at newassignment@dbi-cc.com to submit your building consulting matters directly.
This information only applies to Building Consulting- continue to complete this form for all other Envista consulting services, including forensic engineering, fire investigation, equipment consulting, and digital forensics.
Client Information
Claim Information
Description
Details
Review
Client Information
Name
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Company
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Email Address
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Work Address
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Work Phone Number
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Job Title
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Billing Address
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Claim Information
Claim Number
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Date Of Loss
{{dateOfLoss}}
Claim Amount
{{claimAmount}}
Insured's Name
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Insured Contact Name
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Insured's Phone Number
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Insured's Email Address
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Insured's Address
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Loss Location
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Description
Description of Loss
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Scope of Work
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Files
-
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Details
Requested Expert
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Discuss Budget Y/N
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First Time Using Envista Y/N
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How did you hear about us?
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How did you hear about us? (other)
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Client Information
Case Information
Description
Details
Review
Client Information
Name
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Company
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Email Address
{{emailAddress}}
Work Address
{{addressLine1}} {{addressLine2}}
{{city}}, {{state}}{{canadianProvince}} {{postalCode}}
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Work Phone Number
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Job Title
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Billing Address
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{{billingAddressCity}}, {{billingAddressState}}{{billingAddressCanadianProvince}} {{billingAddressPostalCode}}
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Case Information
Do You Want a Sales Person To Contact You?
{{salesPersonContact}}
Is a case being submitted?
{{submittingACase}}
Parties Involved
{{partiesInvolved}}
Case
{{caseInfo}}
Loss Address
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{{lossAddressCity}}, {{lossAddressState}}{{lossAddressCanadianProvince}} {{lossAddressPostalCode}}
{{lossAddressCountry}}
Description
Description of Loss
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Scope of Work
{{whatDoYouWantUsToDo}}
Files
-
{{attachFilesInfo}}
Details
Requested Expert
{{requestSpecificExpert}}
Discuss Budget Y/N
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First Time Using Envista Y/N
{{firstTimeUsingEnvista}}
How did you hear about us?
{{howDidYouHearAboutUs}}
How did you hear about us? (other)
{{howDidYouHearAboutUsOther}}
Client Information
Claim Information
Carrier Information
Description
Details
Review
Client Information
Name
{{firstName}} {{lastName}}
Company
{{company}}
Email Address
{{emailAddress}}
Work Address
{{address1}} {{insuranceAdjuster_address2}}
{{city}}, {{insuranceAdjuster_state}}{{canadianProvince}} {{postalCode}}
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Work Phone Number
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Job Title
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Billing Address
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{{billingAddressCity}}, {{billingState}}{{billingCanadianProvince}} {{billingAddressPostalCode}}
{{billingAddressCountry}}
Claim Information
Claim Number
{{claimNumber}}
Date Of Loss
{{dateOfLoss}}
Claim Amount
{{claimAmount}}
Insured's Name
{{insuredsName}}
Insured Contact Name
{{insuredContactFirstName}} {{insuredContactLastName}}
Insured's Phone Number
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Insured's Email Address
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Insured's Address
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{{insuredsCity}}, {{insuredsState}}{{insuredsCanadianProvince}} {{insuredsPostalCode}}
{{insuredsCountry}}
Loss Location
{{lossAddressLine1}} {{lossAddressLine2}}
{{lossAddressCity}}, {{lossAddressState}}{{lossCanadianProvince}} {{lossAddressPostalCode}}
{{lossAddressCountry}}
Carrier Information
UMR (Unique Market Reference)
{{lloydsUMR}}
UCR (Unique Claim Reference)
{{lloydsUCR}}
OSND (Original Signing Number and Date)
{{lloydsOSND}}
Order (% of responsibility)
{{lloydsOrder}}
Lloyd’s lead (Lead syndicate on the policy)
{{lloydsLeadSyndicate}}
UW contact (Underwriter contact)
{{lloydsUWContact}}
Description
Description of Loss
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Scope of Work
{{whatDoYouWantUsToDo}}
Files
-
{{attachFilesInfo}}
Details
Requested Expert
{{requestSpecificExpert}}
Discuss Budget Y/N
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First Time Using Envista Y/N
{{firstTimeUsingEnvista}}
How did you hear about us?
{{howDidYouHearAboutUs}}
How did you hear about us? (other)
{{howDidYouHearAboutUsOther}}
Client Information
Description
Review
Client Information
Name
{{firstName}} {{lastName}}
Company
{{company}}
Email Address
{{emailAddress}}
Work Address
{{addressLine1}} {{addressLine2}}
{{city}}, {{state}}{{canadianProvince}} {{postalCode}}
{{country}}
Work Phone Number
{{phoneNumber}}
Job Title
{{jobTitle}}
Billing Address
{{billingFirstName}} {{billingLastName}}
{{billingAddressLine1}} {{billingAddressLine2}}
{{billingAddressCity}}, {{billingAddressState}}{{billingCanadianProvince}} {{billingAddressPostalCode}}
{{billingAddressCountry}}
Description
Description of Loss
{{briefDescriptionOfLoss}}
Scope of Work
{{whatDoYouWantUsToDo}}
Files
-
{{attachFilesInfo}}
How did you hear about us?
{{howDidYouHearAboutUs}}
How did you hear about us? (other)
{{howDidYouHearAboutUsOther}}
Thank You!
Your form has been submitted!
If you have just submitted a building consulting matter, your project will be handled by our sister-company, DBI Consultants. They will be in touch with you shortly to establish contact and coordinate project assignment. Contact newassignment@dbi-cc.com if you need to reach DBI urgently.
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