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Create new Quote Application:
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Applicant
Property Locations
General Liability
Prior Insurance & Claims
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DBA
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City
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Descr. of Operations
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# Building Locations
Building Location #1
*
Description / Use
*
Location Address
*
Type of Construction
select
Modular
Aluminum
Concrete Block
Brick
Brick and Block
Brick and Block Custom
Common (Solid) Brick
Solid Brick
Solid Brick Cust
Brick Veneer
Cement/Concrete Block
Poured Concrete
Barn
Earth Shelter
Frame
Greenhouse Wall
Joisted Masonry
Silo
Log
Modified Fire Resistive
Mill (Heavy Timber Joisted Masonry)
Mineral Fiber
Masonry Non-Combustible
Masonry
Non-Combustible
Other
Plain Concrete
Plate Steel
Plywood
Painted Masonry
Pole
Precast Concrete
PreEngineered Metal
Precast Stone
Protected Steel Frame
PVC
Fire Resistive/Superior
Rail
Reinforced Concrete
Sheet Metal
Slump Block
Superior Masonry Non-Combustive
Split Block
Split Rail
Solid Stone
Steel
Steel Frame
Granite/Stone
Stone and Block
Stone and Block Custom
Artificial (Cultured) Stone
Native Stone
Solid Stone Custom
Manufactured Home / Mobile Home / Trailer
Temporary Hardboard
Concrete Tilt-Up
Masonry Veneer
Vinyl
Window Wall
Barbed Wire
Wood and/or Plaster Board
Woven Wire without Barbed Wire
Woven Wire with Barbed Wire
*
Year Built
select
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
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2016
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2020
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2023
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2025
2026
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
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1919
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2011
2012
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2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
*
Total SQ FT
*
# Units
*
# Fire Divisions
*
# Story
*
# Passenger Elevators
*
# Freight
*
# Separate Structures
(other than parking)
*
Describe Other Structures
*
Resident Manager
Yes
No
*
# Yrs Experience
*
Property Manager
Yes
No
*
# Yrs Experience
*
On Site Property Manager / Office
Yes
No
*
Owner Lives On Site
Yes
No
Premises Information
Subject of insurance
Amount
Coinsurance
Valuation
Blanket
Deductible
Subject of insurance
select
Access Gate
Accounts Receivable
Accounts Receivable in Transit
Additional Covered Property
Additional Flood Building
Additional Flood Personal Property Contents
Additional Peak Season
Advertising Expenses
Alcoholic Beverage Tax
Animal
Arson Reward
Auto Service Protection
Awning
Backup - Sewers and Drains
Beaches
BI Ordinary Payroll
Boat Dock
Boat Slip
Boiler and Machinery Basic
Boiler and Machinery Broad
Boiler and Machinery Spoilage
BOP Building Coverage Rating DTLs
Broad Form Contributing Locations
Broad Form Leader Locations
Broad Form Manufacturing Location
Broad Form Recipient Locations
Broadcasting Tower
Builders Risk
Builders Risks New
Builders Risks with Renovations
Builders Risks without Renovations
Building
Building Materials and Supplies of Others
Building Ordinance Demolition Cost
Building Ordinance Increased Cost of Construction
Building Ordinance or Law
Building Under Construction
Burglary and Robbery
Burglary and Robbery (Money)
Burglary and Robbery (Stock)
Burglary/Robbery Safeguard
Business Income - Landlord as Additional Insured (Rental Value)
Business Income - Loss of Utilities
Business Income Any Other Location
Business Income Exhibition, Fair, Tradeshow
Business Income From Civil Authorities
Business Income From Dependent Properties
Business Income in Transit
Business Income International Air Shipments
Business Income Professional
Business Income with Extra Expense
Business Income without Extra Expense
Business Personal Property
Business Personal Property - Expanded Coverage
Business Protection
Businessowners Policy Enhancement Endorsement
Canopy
Care Custody and Control - Personal Property
Care, Custody and Control Legal Liability - Building
Care, Custody or Control Legal Liability
Church Special Provisions
Clubhouse
Combined Building
Combined Building and Contents
Combined Contents
Combined Demolition Cost and Increased Cost of Construction
Commercial Articles
Commercial Condo Unit - Owners Loss Assessment
Commercial Condo Unit - Owners Misc Real Property
Computer Fraud and Funds Transfer Fraud
Computer Virus
Condo Association Building
Condo CommUnit
Consequential Loss
Contamination and Pollution
Contingent Business Income
Contractor's Equipment
Cost of Prep Inventory and Appraisal
Counterfeit Paper/Money Order
Customer's and Guests' Personal Property
Customers' Personal Property
Debris Removal
Deferred Payments Any Premises
Depositor's Forgery
Detached Carport
Detached Drive-Thru Car Wash
Earthquake
Earthquake Sprinkler Leakage
EDP Electrical Disturbance
EDP Mechanical Breakdown
Electronic Data
Electronic Data Processing (EDP) Equipment
Electronic Data Processing (EDP) Equipment in Transit
Electronic Data Processing (EDP) Exhibition, Fair, Tradeshow
Electronic Data Processing (EDP) Hardware
Electronic Data Processing (EDP) Leased/Rented Equipment
Electronic Data Processing (EDP) Media in Transit
Electronic Data Processing (EDP) Media/Data (Software)
Electronic Data Processing (EDP) Property Any Other Location
Electronic Data Processing (EDP) Property in Transit
Electronic Data Processing (EDP) Property on Premises
Electronic Data Processing (EDP) Software
Electronic Data Processing (EDP) Telephone Equipment
Employee Dishonesty
Equipment Breakdown Coverage
Extra Expense
Extra Expense Expanded Limits on Loss Payments
Fence Coverage
Fine Arts
Fine Arts in Transit
Fire Department Service Charge
Fixtures
Fixtures, Improvements and Alterations
Florist Protection
FoodContamination
Forgery Or Alteration
Furniture
Gasoline
Gazebo
Glass
Gold and Silver - Dentist's Office
Golf Course Coverage
Guard Shack
Guests' Personal Property
Home Business Protection
Household Property
Hydro-Static Pressure Caused Collapse to Underground Water
Identity Recovery
Inc Lmt for Fire Dept Serv Chrg
Increase Electronic Data Processing (EDP)
Increased Accounts Receivable
Increased Valuable Papers
Inflation Guard
Installation
Installation Any Job Site
Interruption of Computer Ops
Inventory or Appraisals
Laundry Building
Leasehold Interest
Leasehold Interest - Improvements and Betterments
Legal Liability
Light
Limited Coverage for Fungus, wet or dry rot, and bacteria.
Limited Form Contributing Locations
Limited Form Leader Locations
Limited Form Manufacturing Locations
Limited Form Recipient Locations
Machinery, Equipment
Mass Tenants Relocation
Mercantile/Service
Mine Subsidence
Money And Securities - Peak Season
Money And Security
Monies and Securities off Premises
Monies and Securities on Premises
Monies and Securities On/Off Premises
Newly Acquired Property
Newly Acquired Property - Personal
Non-owned Detached Trailer
Off Premises Power Failure
Operations
Optional Building - Legal Liability
Optional Personal Property - Legal Liability
Other
Outdoor Property
Outside Signs
Peak Season
Peak Season Personal Property
Personal Property
Personal Property Any Other Location
Personal Property Excluding Stock
Personal Property Exhibition, Fair, Tradeshow
Personal Property Floater
Personal Property of Employees
Personal Property of Others - Condo Association
Personal Property of Others - Condo Unit Owners
Personal Property of the Deceased
Pollutant Cleanup and Removal
Premier Office Package
Print Mistake Coverage - Per Person
Property In The Open
Property In Transit
Property of Others
Property Off Premises
Property Other Than Stock
Property Plus
Protective Safeguard
Radio / Television (TV) Antenna
Recharging of Fire Extinguishers Supplementary Systems
Reconstruction Cost (Museum)
Refrigerated Products
Re-keying of Locks
Relocation Expense
Renovations Under Construction
Rental Income
Research and Development Property
Restaurant Equipment
Salespersons Samples
Scheduled Personal Property
School Violent Event Response
Separation of Coverage
Separation of Coverage - Condo Association
Separation of Coverage - Condo Unit Owners
Service Station
Sign
Spoilage
Spoilage - Business Income
Stained Glass
Stock
Stock Stored in the Open
Storage Shed
Swimming Pools
Systems Breakdown - Basic
Systems Breakdown - With Boilers
Systems Breakdown - Without Boilers
Theft of Building Materials
Transportation
Travel Agent Endorsement
Utility Services Direct Damage
Utility Services Time Element
Valuable Papers
Vehicular Damage
Water Back-up & Sump Overflow
Welfare and Pension Plan (ERISA)
Your Business Personal Property - Condo Association
Your Business Personal Property - Condo Unit Owners
Amount
Coinsurance
Valuation
select
Actual Cash Value
Replacement Cost
Agreed Amount
Marked Value
Blanket
Deductible
Remove Premises
Add Premises
Commercial Occupancies
Occupancy Type
Occupancy Description
Occupied %
select
Absentee Owner
Course of Construction
Occupied
Other
Owner
Owner and Tenant
Partially Vacant
Tenant
Unoccupied
Vacant
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Each Occurence
Damage To Rented Premises
(Ea occurence)
Med Exp
(Any one person)
Personal & Adv Injury
General Aggregate
PRODUCTS-COMP / OP AGG
Table of Hazards
Loc #
Haz
Classification
Exposure
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1
select
Units
Area
Sales
Other
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Prior Insurance & Claims
Step
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Prior Insurance Information
*
Present Insurance Carrier
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select
*
Is Carrier Offering Renewal
Yes
No
*
If No, Why? Explain
*
Policy Number
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Expiration Date
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How Long With This Carrier
select
< 1 Year
1-2 Years
2-3 Years
3-4 Years
4-5 Years
> 5 Years
If Less Than 5 Years, List All Prior Carriers & Policy Numbers On
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Claims Information
(Last 5 Years)
*
Are Loss Runs On File?
Yes
No
*
If No, Have They Been Requested?
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No
*
Date Requested
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Any Claim for Sexual Abuse / Molestation?
Yes
No
*
If Yes, Describe
*
# Claims
Claim #1
*
Carrier Name
select
select
*
Policy Number
*
Date Of Loss
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Description Of Loss
*
Amount Paid
*
Amount Reserved
*
Claim
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