Property Insurance – Building and/or Contents Quote

Named Insured*

Contact Name*

First

Last

Email*

Phone*

Legal Entity Type*

Sole Proprietorship
Partnership
LLC
Corporation

I would like a quote for the following*

Building AND Contents
Building Only
Contents Only

How many buildings are you wishing to insure?*

If you wish to insure more than one building, please submit an application for each building. You will receive one quote based on the information received from all applications.

Building Information

If requesting a quote for Contents Only, we will still need the building information where the contents is located.

Address*

Street Address

City

State

ZIP Code

Status*

Own
Rent
Home Office

Building Occupied Primarily As:*

ex: office, warehouse, manufacturing, etc.

Year Built	Sq. ft. area

Sprinklered?*

Yes
No

Inside City Limits*

Yes
No

Number of Stories*

Building Improvements

Wiring- Year Updated

Plumbing- Year Updated

Heating- Year Updated

Roof- Year Updated

Roof Type

Building - Type of Construction

Frame (wood wall supports and roof supports)
Joisted Masonry (concrete/block wall supports and wood roof supports)
Non-Combustible (metal wall supports and roof support)
Masonry Non-Combustible (concrete wall supports and metal roof supports)
Fire Resistive (concrete wall supports and concrete roof supports)

Amount of Insurance Needed ($) For 100% Replacement (Brand New):

Building:*

Furniture/ Equipment/ Contents:*

Computer Hardware/ Software:*

Tenants Improvements & Betterments:*

Inventory:*

Raw Stock:*

Other - Describe

Other Replacement Cost:*