Apartment Building Insurance Quote Request Apartment Building Insurance Quote Request For your protection and security, the information you provide is sent to us via a secured server. Please fill out this form as completely as possible to ensure an accurate request.Complete the following information if you would like to obtain a quote on Apartment Building Insurance. Please understand this is not an application for insurance. An application will be sent to you if coverage is desired. All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.Personal InformationSelect Your StatePlease Note: We only write insurance for these states.SelectNew HampshireVermontMailing AddressWhat is your mailing address? Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name*What is your name? First Last Home Telephone NumberWhat is your home telepone number?Work Telephone Number*What is your work telepone number?Email Address*What is your email address? FaxWhat is your fax number? Property InformationProperty AddressWhat is the property address? Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code UnitsHow many units are in the building?Please enter a number greater than or equal to 0.Vacant UnitsHow many units in the building are vacant?Please enter a number greater than or equal to 0.Year BuiltWhat year was it built?Please enter a number from 1700 to 3000.Purchase DateWhat date was the property purchased? MM slash DD slash YYYY Construction TypeWhat as the construction type?SelectBrickStoneFrameMasonrySuperiorLog CabinFrame-StuccoMasonry VeneerStoriesHow many stories?Please enter a number from 0 to 99.Ground Floor Square FootageIf two or more stories, what is the ground floor square footage?Please enter a number greater than or equal to 0.Total Square FootageWhat is the total square floor square footage of the building?Please enter a number greater than or equal to 0.What foundation type?SelectCrawl spacePiers/Pillings/StiltsSlab on gradeUnfinished basementWalkout basementWood foundation basementIf sructure is located in a flood zone, what is the distance to body of whater?SelectDo not live in flood zoneLess than 100 feet100 to 500 feet500 to 1000 feetMore than 1000 feetWhat type of garage?SelectNo Carport - Garage1 Car Carport - Attached2 Car Carport - Attached1-4 Car Carport - Detached5 or More Car Carport - Detached1-4 Car Garage - Attached5 or More Car Garage - AttachedWhat type of roof covering?SelectArchitectural shinglesAsphalt/Fiberglass shinglesBuilt-up/Tar and gravelClay tileConcrete tileCorrugated steelMineral fiber shakesMission TileRock roofRoll roofingRubber roofSlateTinWood fiber shinglesWood shakeWas the roof updated? Yes No If yes, what year?Year Roof UpdatedPlease enter a number from 1700 to 3000.Does the building have a pool?Pool Yes No Is the pool fenced?Pool Fence Yes No Does the pool have a diving board?Pool Diving Board Yes No Does the pool have a slide?Pool Slide Yes No What is the distance of fire protection?Select1000 ft or less to hydrant & 5 mi or less to fire stationOver 1000 ft to hydrant & 5 MI or less to fire stationOver 5 & up to 10 MI to fire stationOver 10 MI to fire stationBrushIs the building in the brush? Yes No Brush Within 1 MileIs there a brush hazard within one mile of the building? Yes No If yes, has the brush been cleared by 250 feet from all sides of the building?Brush Cleared by 250 Feet Yes No Smoke AlarmIs there a smoke alarm? Yes No Fire ExtinguisherIs there a fire extinguisher? Yes No DeadboltsAre there deadbolts? Yes No Electrical UpdateIs the electrical updated? Yes, Recently Updated No Circuit BreakersAre there circuit breakers? Yes No Copper WiringDoes the electrical circuit box have copper wiring? Yes No Age of Heating/ Air ConditioningHow old is the heating/ air conditioning? Thermostatically ControlledIs the heading/ air conditioning thermostatically controlled? Yes No Energy SourceWhat is the energy source?SelectGasElectricalHeating SystemWhat is the heating system?SelectNoneHeat pumpElectricGasOilCooling SystemWhat is the cooling system?SelectNoneCentral airEvaporative coolerPlumbing UpdatedHas the plumbing been updated? Yes No CopperIs the plumbing copper? Yes No Automatic Fire SprinklersDoes the building have interior automatic fire sprinklers? Yes No Theft AlarmIs there a theft alarm? Yes No Fire AlarmIs there a fire alarm? Yes No Earthquake ZoneWhat is the earthquake zone? Has it been earthquake retrofittedSelectNot Required, Home Built After 1975Yes, Recently Bolted-Retrofitted for EQNoFire DistrictWhat is the fire district? Dogs on PropertyAre there dogs on the property? Yes No If yes, how many and what is the breed of each dog?Pets or AnimalsAre there any other pets or animals on the property? Yes No If yes, how many and what is the description of each?Current Coverage InformationWhat is the current insurance company? Losses - ClaimsWere there any losses or claims in the last 5 years? Yes No If yes, what is teh date, amount paid, and description of each loss or claim?Desired Coverage InformationDwelling AmountCoverage A Other StructuresCoverage B Personal PropertyCoverage C Loss of UseCoverage D Premise of LiabilityCoverage ESelect$100,000$300,000$500,000Policy DeductibleAmountSelect100250500750100025005000Earthquake DeductibleIf earthquake insurance is requested, select deductible percentage %SelectNo Earthquake Coverage10%15%20%25%30%Do you want building replacement cost coverage? Yes No Do you want contents replacement cost coverage? Yes No CaptchaPLEASE NOTE: Insurance coverage cannot be bound without a written binder from our office.Please Also Note: Many insurance carriers use information gathered from you and outside sources about your claim, credit history and home. This information allows insurance companies to determine accurately the proper price to charge. You are entitled to a free copy of the reports by contacting the appropriate consumer reporting agency within the next 60 days.