Homeowners Flood Quote

Complete the following information if you would like to obtain a quote. Please understand this is not an application. 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.

Personal Information

Name
Business Name
Street Address
City
State
Zip Code
Phone Number
Alternate Telephone
Fax Number
Email Address
Building & Property Information
Property Street Address
City
State
Zip Code
Occupancy Type
Building Type
Year Built
Flood Map Zone Number
Community Flood Number
Number of Bedrooms
Number of Bathrooms
Number of Fireplaces
What date was the property purchased?
Does the residence have a basement?
Total Square Footage of Building
How many units are in the building?
Garage Description
How many stories is it?
What is the construction type?
What is the foundation type?
What is the nature of sub-soil?
What is the topography?
What type of roof covering?
Is the roof updated?
If yes, what year?
Is there any erosion in the area?
Is there any below ground parking?
Is there any soft first story or tuck under parking?
What is the distance to fire protection?
Is the business in a brush area?
If yes, has the brush been cleared by 250 feet from all around the building?
Are there smoke detectors at this location?
Are there fire extinguishers?
Are there circuit breakers?
Is the electrical updated?
How old is the heating/ air conditioning?
What is the energy source?
Has the plumbing been updated?
If yes, what year was the plumbing updated?
Is the plumbing copper?
Does the building have interior automatic fire sprinklers?
Is there a fire alarm?
Has the building been retrofitted or bolted?
Claims Information
Were there any losses or claims in the last 5 years?
If yes, what is the date, amount paid and description of each loss or claim?
Coverage Information
Current Insurance Company
How much are you paying now?
What is the building coverage requested?
What is the other structures coverage requested?
What is the contents property coverage requested?
What is the loss of use coverage requested?
Best Time To Contact You
Please let us know the best time to call and discuss your quote.
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