Apartment Building Insurance Quote

Apartment Building Insurance Quote Request

Complete the following information if you would like to obtain a 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 Information
*First Name
*Last Name
Mailing Address
City/St/Zip
Phone Number
Alternate Number
Birth Date
*Email Address
Property Information
Property Street 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?
What is the construction type?
How many stories is it?
If two stories, what is the ground floor square footage?
What is the total square footage of the building?
What foundation type?
If structure is located in a flood zone, what is the distance to body of water?
Garage Description
What type of roof covering?
Was the roof updated?  Yes No
If yes, what year?
Does the building have a pool?  Yes No
  If yes, is it fenced?  Yes No
If there is a pool, is there a diving board?  Yes No
If there is a pool, is there a slide?  Yes No
What is the distance to fire protection?
Is the building in the brush?  Yes No
Is 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?  Yes No
Is there a smoke alarm installed?  Yes No
Is there a fire extinguisher?  Yes No
Are there deadbolts?  Yes No
Is the electrical updated?  Yes No
Are there circuit breakers?  Yes No
Does the electrical circuit box have copper wiring?  Yes No
How old is the heating/ air conditioning?
Is the heating / air conditioning thermostatically controlled?  Yes No
What is the energy source?
What is the heating system?
What is the cooling system?
Has the plumbing been updated?  Yes No
Is the plumbing copper?  Yes No
Does the building have interior automatic fire sprinklers?  Yes No
Is there a theft alarm?  Yes No
What is the earthquake zone?
Has it been earthquake retroffited?
Tenant occupied?  Yes No
Are there dogs on the property?  Yes No
If yes, how many and what is the breed of each dog?
Are there any other pets or animals on the property?  Yes No
If yes, how many and what is the description of each?
Current Coverage Information
Current Insurance Company
Expiration Date
Were there any losses or claims in the last 5 years?  Yes No
If yes, what is the date, amount paid and description of each loss or claim?
Desired Coverage Information
Dwelling Amount - Coverage A
Other Structures - Coverage B
Personal Property - Coverage C
Loss of Use - Coverage D
Premise Liability - Coverage E
Policy Deductible
If earthquake insurance is requested, select deductible percentage %
Do you want building replacement cost coverage?  Yes No
Do you want contents replacement cost coverage?  Yes No
Questions or Comments
Best Time To Contact You
Please let us know the best time to call and discuss your quote  Morning Afternoon Evening Anytime Or Specify Other:
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