Tel. 1-800-462-2604

Pay by credit cards to buy Insurance.

 

General Information

 
Name:
Name of Legal Entity, if other
Phone:
Email:
DBA: (Doing Business As)
Mailing Address:

City: 

State: 

  Zip Code:
Building Address:

City: 

State: 

  Zip Code:
 
Ownership type:
How many years in apartment ownership business?
 years
How many years at this location?
 years
Do you currently have insurance?
If yes, Number of years continuously insured:
 years
Name of Current Insurance Company:
Policy No:
Losses-claims in the last 5 years:
If any Losses, provide date, amount paid and reserves, description, and steps taken to avoid future losses:
Has your insurance ever been canceled or non-renewed?
If yes for what reason?

Building Information

How many units in the building?

units

Total size of building:

sq/feet

Year of construction:

Building construction type:


If over 30 years old, was the following updated? if so, when?

Wiring/Year:    Plumbing/Year:    Roof/Year:    Heating/Year:

Is there a Burglar Alarm? 

If Yes, Select the Type:

Is there a Fire Alarm? 

If Yes, Select the Type:

Does the building bave sprinklers?
How many fireplaces are there in the building?
How many laundry units are there in the building?
Garage Type:
Number of parking spaces:
List any additional features or special items applying to your building:

Coverage

Amount of  Building Coverage:

Deductible:

Total Monthly Gross Rent:
Total Value of Any Personal Property You Own Located in this Building:
Amount of Liability Coverage Needed:
Need Umbrella Protection?

If yes, How much protection do you need?

    

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