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Quote Application
Business Information
Property Location
Building Overview
Prior Insurance & Claims
Coverages
Business Information
*
Named Insured
*
Address Line 1
*
Address Line 2
*
City
*
State
select
Add New
*
ZIP
*
DBA
*
FEIN #
*
Phone
*
Cell Phone
*
Fax
*
E-mail
*
Owned Property Since
select
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
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1919
1920
1921
1922
1923
1924
1925
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1927
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1931
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1987
1988
1989
1990
1991
1992
1993
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1996
1997
1998
1999
2000
2001
2002
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2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
*
Number Years Experience
*
Policy Expiration Date
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*
# Building Locations
Building Location #1
*
Property
select
*
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
1915
1916
1917
1918
1919
1920
1921
1922
1923
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1925
1926
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1929
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1931
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1961
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1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
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1929
1930
1931
1932
1933
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1968
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1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
*
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
Back
Continue
Building Overview
Step
/
Building Safety
Circuit Breakers
Yes
No
Smoke Detectors
Yes
No
Is Building In A Gated Community or Have Security Gates?
If Yes, Describe
Yes
No
Is The Building Designed For Its Current Type Of Operations?
Yes
No
Was Any Building Converted From A Different Type Of Occupancy?
If Yes, Describe
Yes
No
Any Wood Burning Stoves?
Yes
No
Any Charcoal Barbecues Used On Wood Decks, Patios Or Balconies?
Yes
No
Are All Exterior Doors Equipped With Deadbolt Locks?
Yes
No
Is There A Change Locks Procedure?
Yes
No
Hard Wired
Yes
No
Carbon Monoxide Detectors
Yes
No
Fire Extinguishers
If Yes,
#
Tagged / Up-to-date
Yes
No
Interior Hallways / Stairs?
If Yes, Fire Doors
Yes
No
Auto-Closing Doors
Yes
No
Yes
No
Does The Building Have Standpipes On Each Floor?
If Yes,
# Each floor
If Interior Hallways, Are There Approved And Posted Evacuation Plans?
Yes
No
Railings Less Than 4 inches (If over 4″)
If Yes, Willing To Modify
Yes
No
Yes
No
Any Non-Releasable Window Bars?
If Yes, Will They Be Removed
Yes
No
Yes
No
Fire Alarms
Yes
No
Central Station / Monitored
Yes
No
Any Burglar Alarms or Monitored Security?
If Yes, Describe
Yes
No
Building Sprinklers
If Yes,
%
Garage Areas
If Yes,
%
Building Sprinklers Inspected in Last 5 Years?
If Yes, Date
RadDatePicker
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Yes
No
Building Sprinklers Regularly Monitored / Maintained
If Yes, Describe
Yes
No
Building Sprinklers — Is there A Current Sprinkler Certificate?
Yes
No
# Pools
If Yes,
# Spas
If Yes,
Pools / Spas Fenced
Fence Over 5ft
Yes
No
Yes
No
Pool / Spa: Is there a self-closing, self-locking gate?
Yes
No
Any Diving Board or Slides?
Yes
No
Is Depth Of Pool Marked And Pool Rules Posted?
Yes
No
Are Safety Rules Posted And Life Saving Apparatus Available?
Yes
No
Are All Pools / Spas Equipped With Anti-entrapment Device And/Or System For Drain Cover?
Yes
No
Are There Armed Guards On The Premises?
Yes
No
Is There a Written Safety Plan?
Yes
No
How often is property inspected
If Yes,
months
Are There Any Signs Of Pre-Existing Or Water Damage To the Building?
If Yes, Describe
Yes
No
Any Roads Maintained or Owned?
If Yes, Describe
Yes
No
Any Recreation Rooms?
If Yes, Describe
Yes
No
Any Tennis, Racquet, Or Other Courts?
If Yes, Describe
Yes
No
Any Playgrounds? If Yes, Describe Type of Surface
If Yes, Describe
Yes
No
Any Saunas or Steam Rooms?
If Yes, Describe
Yes
No
Any Ponds, Lakes, or Streams?
If Yes, Describe
Yes
No
Any Greenbelts or Parks?
If Yes, Describe
Yes
No
Does The Property Have Marina Docks Or Lakefront?
If Yes, Describe
Yes
No
Is There Any Timeshare Or Short Term Rentals?
If Yes, Describe
Yes
No
If Habitational, Are There Any Risks That Are Not Habitational?
If Yes, Describe
Yes
No
Employee Training
Yes
No
Employee Screening
Yes
No
Any Uncompleted Recommendations?
If Yes, Describe
Yes
No
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Building Updates Quick View
Wiring Updated
Yes
No
Year
select
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Any Aluminium
Yes
No
Plumbing Updated
Yes
No
Year
select
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Plumbing Type
select
Cast Iron
Copper
Other
PVC
Roof Replaced
Yes
No
Year
select
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Roof Repaired
Yes
No
Year
select
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Roof Type
select
Aluminum Shingles
Architectural Shingles
Asbestos
Asphalt Shingle
Built Up without Gravel
Cedar Shakes
Cedar Shingles
Clay Tile or Slate
Composition (Fiberglass, Asphalt, etc.)
Concrete Tile
Concrete (Not Tile)
Reinforced Concrete
Copper
Fiberglass
Foam
Gravel
Light Metal Panel
Single Ply Membrane Ballasted
Metal
Mineral Fiber
Mission Tile
New England Pine Shingle
Other
Plastic
Plywood
Poured
Recycled Roofing Products
Rock
Rolled Roofing
Rubber Roof
Seam Metal
Slate
Single Ply Membrane Systems
Spanish Tile
Corrugated Steel
Steel/Porcelain Shingles
Tar and Gravel
Tar and Gravel (Built-up)
Tile
Tin
Unknown
Victorian Scalloped Shake
Wood Fiber Shingles
Wood Shakes
Wood Shingles
Wood Shake/Shingle
Heating Updated
Yes
No
Year
select
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Last Painted
Year
select
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Renovation
%
Year
select
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Describe All Renovations
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Continue
House Keeping Quick View
Driveways, Parkways Free Of Excessive Oil / Grease Buildup
Yes
No
All Walk / Park Surfaces Smooth And Even?
(No Potholes Or Tripping Cracks On Surface)
Yes
No
Any Graffiti On Any Part Of The Building?
Yes
No
Any Abandoned Vehicles On The Property?
Yes
No
Trees & Shrubs Trimmed Away From Building
Yes
No
Landscaping Maintained
Yes
No
Overall Rating Of Property
select
Poor
Below Average
Average
Very Good
Excellent
Back
Continue
Prior Insurance & Claims
Step
/
Prior Insurance Information
*
Present Insurance Carrier
select
select
*
Is Carrier Offering Renewal
Yes
No
*
If No, Why? Explain
*
Policy Number
*
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
Next Step
.
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Claims Information
(Last 5 Years)
*
Are Loss Runs On File?
Yes
No
*
If No, Have They Been Requested?
Yes
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
select
Open
Closed
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Coverages & Annual Premiums
*
Building Coverage Limits
*
Blanket Coverage
Yes
No
*
Valuation
select
ACV
RC
ERC
GRC
*
Business Property Limits
*
Rental / Income / Fees Limits
*
General Liability Limits
*
Umbrella / Excess Liability
Yes
No
If Yes, Limits
Premium
*
Property Deductible
*
Liability Deductible
*
Annual Premium
*
Earthquake
Yes
No
Premium
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