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Owner
Tenant
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| Dwelling justquotesrmation |
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| Type
of Building: |
Apartment
Condominium
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Occupancy
Type Description:
(describe entities & and number
of units, such as "4 unit apartment", "12 Unit
Condminium, or "2 Offices and Barber Shop", etc.) |
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| Type
foundation: |
Slab
Crawlspace over slab
Pier & Post
Other (list in remarks) |
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| Type
finished basement, if any: |
None
Full
25%
50%
75% |
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| Type
Roof: |
Shingle
Wood Shake
Tar/Gravel
Spanish Tile
Metal
Other |
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| Type
of Siding |
Brick
Vinyl
Wood
Aluminum
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| Number
of stories: |
One
Two
Three
4 or more |
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#
of feet to nearest
fire hydrant:
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#
of miles to nearest
fire station:
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| Currently
Insured? |
Yes
No |
| Name
of Carrier & how long insured? |
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| Prior
Claims? |
Yes
No |
| Describe
claims in detail: |
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| Plumbing
type: |
Copper
Galvanized
Mixed (Copper/Galvanized) |
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Coverages: |
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Building
Cov. $
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Contents
$
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Liability
Cov. $
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Deductible
$
($250, $500, $1,000, etc.)
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Other
Coverage/Remarks
(describe any extra coverages needed
such as business interruption, robbery, computers,
etc.)
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