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Condominium Association Insurance Quote Form
Name of Insured Association or Business:
*
Business Type:
*
Condominium Assoc.
Homeowners Assoc.
Cooperative Apartment
Location Address:
*
Policy Type:
*
Coverage for all Buildings
Covers Common Areas Only
City:
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip:
*
Number of Buildings:
Number of Units:
Number of Stories:
Year Built:
Construction Type:
Frame
Joisted Masonry
Non-Combustible
Masonry Non-Combustible
Fire Resistive
Mixed Construction
Total Square Footage:
Total Property Value:
Rental Income (if any):
Year Buildings were last re-roofed:
Is there a sprinkler system in the building(s)?
*
Yes
No
Partial
Smoke Detectors:
*
Hard Wired
Hard Wired with Central Station Monitoring
Battery Operated
Battery in Units; Hard Wired in Common Areas
Please describe the extent of sprinkler coverage:
Current Carrier:
Renewal Date of Current Policy:
Current Deductible:
$1,000
$2,500
$5,000
$10,000
$25,000
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
Digital photos of the Association building(s)
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) Digital photos of the Association building(s)
Contact Name:
*
Property Management Company:
Email Address:
*
Telephone:
Recipient Fax:
Referred By:
Current Client
Friend
Insurance Company
Web Site
Notes/Comments: