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Apartment Bldg. Quote
Dwelling Fire/Apartment Building Insurance Quote
Contact Information
Name of Business:
Contact Name:
Address:
City:
State:
Zip:
Business Phone:
Fax Number:
Contact Email Address:
Property Information
Address of Property:
Property City:
Property State:
Property Zip:
New purchase
Existing ownership
Number of units:
Building Square footage:
Year Built:
Occupancy:
Owner
Tenant
Occupancy Type:
Plumbing type:
Copper
Galvanized
Mixed (Copper/Galvanized)
Foundation Type:
Slab
Crawlspace over slab
Pier & Post
Other (list in remarks)
Type finished basement, if any:
None
Full
25%
50%
75%
Type Roof:
Shingle
Wood Shake
Tar/Gravel
Spanish Tile
Metal
Other
Type of Siding:
Brick
Vinyl
Wood
Aluminum
Number of stories:
1
2
3
4 or more
# of feet to nearest fire hydrant:
# of miles to nearest fire station:
Currently Insured?
Name of Carrier & how long insured?
Yes
No
Coverages
Building Coverage
$
Liability Coverage
$
Contents
$
Deductible $
($250, $500, $1,000, etc.)
$
Other Coverage/Remarks:
(describe any extra coverage's
needed such as businessinterruption,
robbery, computers, etc.):
Any claims reported on this property:
or previously owned properties in
the last 3 years?
Yes
No
Please describe: Include date(s) and:
details of claim
Additional Comments
Please give any additional comments or questions
No coverage of any kind is bound or implied by submitting information via this online form
Information from you and other sources, such as your driving, claims and insurance histories, may be used to calculate an accurate price for your insurance.
We will not distribute information to other parties other than for insurance underwriting purposes.
By submitting this form, you agree to release us from any liability should this information be accidentally viewed by others.
