Apartment Insurance | Homeowners Insurance Quote

Homeowners Insurance

Complete the following information if you would like to obtain a quote on Homeowners Insurance. Please understand this is not an application for insurance. An application will be sent to you if coverage is desired.
All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.

The home may be a single family owner occupied dwelling (home), condo or townhome. This program may provide dwelling fire coverage, contents - personal property, loss of use, separate structures such as a detached garage or shed, premise medical and premise liability insurance.
Complete this form and someone will get back to you to get a quote on a single family owner occupied home, condo or townhouse.

You can also get a quote on: Rental Property (1-4 units), Mobilehome, Apartment Building 5+units)

Name

Street

City

State

Zip

What is your telephone number?

What is your fax number?

What is your email address?

What is your Date of Birth

What is the property address?(Street, City, State, Zip)

What is the dwelling use?

What year was it built?

Purchased Date?

What is the construction type?

How many stories?

What is the total square footage of the building?

What type roof covering?

Was the roof updated?

Yes

If yes, what year?

Does the building have a pool?

Yes

If there is a pool, is it fenced?

Yes

If there is a pool, is there a diving board?

Yes

If there is a pool, is there a slide?

Yes

What is the distance of fire protection?

How old is the heating/ air conditioning?

What is the heating system?

What is the cooling system?

Has the plumbing been updated?

Yes

Is there a fire alarm?

Yes

What is the fire district?

Are there dogs on the property?

Yes

If yes, how many and what is the breed of each dog?

What is the current insurance company?

What is the expiration date of current policy?

Were there any losses or claims in the last 5 years?

Yes

If yes, what is the date, amount paid and description of each loss or claim?

Dwelling Amount (Coverage A)

Other Structures (Coverage B)

Business Property (Coverage C)

Loss of Use (Coverage D)

Premise Liability (Coverage E)

Policy Deductible Amount

Do you want building replacement cost coverage?

Yes

Do you want contents replacement cost coverage?

Yes

Questions or Comments

29 Broadway Suite 1511
New York, NY 10006-3201

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