Homeowners Flood Insurance Quote Request Homeowners Flood 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 an Artisan Contractor Insurance quote. Please understand this is not an application. 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 HampshireVermontWhat is your 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 What is your name?* First Last What is your telephone number?*Email Address*What is your email address? FaxWhat is your fax number? What is your business name? Building & Property InformationWhat 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 What is the occupancy type?SelectOwnerTenantVacantOwner & TenantWhat is the building type?SelectHouseCondo - ContentsTownhomeApartment BuildingOffice BuildingCondo Assoc ComplexHigh Rise BuildingManufacturing BuildingWhat year was it built?Please enter a number greater than or equal to 1300.What is the flood map zone number? What is the community flood number? How many bedrooms?Please enter a number greater than or equal to 0.How many bathrooms?Please enter a number greater than or equal to 0.How many fireplaces?Please enter a number greater than or equal to 0.What date was it purchased? MM slash DD slash YYYY Does the residence have a basement? What is the total square footage of the building?Please enter a number greater than or equal to 0.How many units are in the building?Please enter a number greater than or equal to 0.What is the garage description?SelectNo Carport - GarageCar Carport - AttachedCar Carport - DetachedGarage - AttachedGarage - DetachedTuck Under ParkingAbove Ground ParkingBelow Ground ParkingParking LotStreet ParkingStoriesHow many stories is it?Please enter a number from 0 to 99.What is the construction type?SelectBrickStoneFrameMasonrySuperiorLog CabinFrame-StuccoMasonry VeneerWhat is the foundation type?SelectFlat Slab-Poured Reinforced ConcretePiersWoodStiltsPosts-PilingsBasementMasonryRubble StoneNon-Reinforced ConcreteCraw Space-Concrete PerimeterCraw Space-Wood PerimeterWhat is the nature of sub-soil?SelectSandClayRockMarshFilled LandUnconsolidated GroundNatural Consolidated GroundWhat is the topography?SelectFlatCliffTerracedSteep HillGentle HillsideUnder 100ft to WaterHillside Over 30 DegreesWhat type roof covering?SelectArchitectural shinglesAsphalt/Fiberglass shinglesBuilt-up/Tar and gravelClay tileConcrete tileCorrugated steelMineral fiber shakesMission TileRock roofRoll roofingRubber roofSlateTinWood fiber shinglesWood shakeIs the roof updated? Yes No If yes, what year?Year Roof UpdatedPlease enter a number from 1700 to 3000.Is there any erosion in the area? Is there any below ground parking? Yes No Is there any soft first story or tuck under parking? 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 stationIs the business in a brush area? Yes No If yes, has the brush been cleared by 250 feet from all around the building? Yes No Smoke Detectors Yes No Fire Extinguishers Yes No Circuit Breakers Yes No Is the electrical updated?SelectYes, Recently UpdatedNoHow old is the heating/ air conditioning? What is the energy source?SelectGasElectricalHas the plumbing been updated? Yes No If yes, what year was the plumbing updated?Please enter a number from 1700 to 3000.Is the plumbing copper? Does the building have interior automatic fire sprinklers? Yes No Is there a fire alarm? Yes No Has the building been retrofitted or bolted?SelectNo, Building is Not BoltedYes, Recently Bolted or Retrofitted for EQClaims InformationWere there any losses or claims in the last 5 years?Losses - Claims Yes No What is the date, amount paid and description of each loss or claim?Coverage InformationWhat is the current insurance company? Amount Current CoverageHow much are you paying now? Building CoverageWhat is the building coverage requested? Other Structures CoverageWhat is the other structures coverage requested? Contents Property CoverageWhat is the contents property coverage requested? Loss of Income CoverageWhat is the loss of income requested? Are there any questions, comments or additional coverage required?CaptchaPrint Form