Community Association Insurance Quote Form

Name of Insured Association or Business: *

Business Type: *

Location Address: *

Policy Type: *

City: *

State *

Zip: *

Have we provided a quote for your association in prior years? *

Number of Buildings: *

Number of Units: *

50% or more rental units? *

Number of Stories:

Year Built (or approximate): *

Construction Type:

Total Square Footage:

Total Property Value:

Rental Income (if any):

Year Buildings were last re-roofed:

Smoke Detectors: *

Is there a sprinkler system in the building(s)? *

Yes

No

Partial

Please describe the extent of sprinkler coverage:

Any swimming pools? *

Association own any Autos? *

Check all that apply. *

Pool is fenced in.

Fence has a self closing & latching gate.

Pool has a Slide, Diving Board or Jump Board.

Lifeguards - Independent Contractor

Lifeguards - Employees

Pool is rented out for private parties.

Public membership is permitted.

Current Carrier:

Renewal Date of Current Policy: +

Current Deductible: *

Current Premium:

Any Claims in the Past 3 Years? *

Yes

No

Please attach a current loss run for the Association below or provide information on the claim detail, including the date of the claim(s), amount paid and a brief description of the loss.

If you are requesting a quote for a condominium or community association, our underwriters will need the following information in order to provide a firm quotation.

If you have any of these items available, please check the box next to the item to upload and send the information with this quote request.

A current copy of the Association's claim history (a loss run)

A complete set of the Association's Declarations and By-laws

A current Association budget

A site plan for the community

Copy of Current Policy for coverage review

1) A current copy of the Association's claim history (a loss run)

2) A complete set of the Association's Declarations and By-laws

3) A current Association budget

4) A site plan of the community

5) Copy of Current Policy to review coverages and limits.

Contact Name: *

Property Management Company:

Email Address: *

Telephone:

Recipient Fax:

Referred By:

Notes/Comments: