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.
Please Note: We only write insurance for these states.
What is your mailing address?
What is your name?
What is your home telepone number?
What is your work telepone number?
What is your email address?
What is your fax number?
What is the property address?
How many units are in the building?
How many units in the building are vacant?
What year was it built?
What date was the property purchased?
MM slash DD slash YYYY
What as the construction type?
How many stories?
If two or more stories, what is the ground floor square footage?
What is the total square floor square footage of the building?
Year Roof Updated
Pool Diving Board
Is the building in the brush?
Is there a brush hazard within one mile of the building?
Brush Cleared by 250 Feet
Is there a smoke alarm?
Is there a fire extinguisher?
Are there deadbolts?
Is the electrical updated?
Are there circuit breakers?
Does the electrical circuit box have copper wiring?
How old is the heating/ air conditioning?
Is the heading/ air conditioning thermostatically controlled?
What is the energy source?
What is the heating system?
What is the cooling system?
Has the plumbing been updated?
Is the plumbing copper?
Does the building have interior automatic fire sprinklers?
Is there a theft alarm?
Is there a fire alarm?
What is the earthquake zone?
What is the fire district?
Are there dogs on the property?
Are there any other pets or animals on the property?
Current Coverage Information
Were there any losses or claims in the last 5 years?
Desired Coverage Information
If earthquake insurance is requested, select deductible percentage %
PLEASE 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.