Quote Sheet: Condo

Personal Information
Name:*
Address
Effective date:
Year built:
Date purchased:
Date Format: MM slash DD slash YYYY
Square feet:
Number of Stories:
Construction type (ie stucco/frame):
Style (ie ranch):
Roof type (ie asphalt/concrete tile):
Foundation (ie slab or basement):
Number of:
Bedroom Bath 1/2 Bath 3/4 Bath Household Members Car Garage
Garage type:
Check box if condo has cooling, heating, or both:
- Cooling
- Heating
Updates
Roofing Year:
Roofing Full/Partial:
Heating Year:
Heating Full/Partial:
Plumbing Year:
Plumbing Full/Partial:
Plumbing Type
Electric Year:
Electric Full/Partial:
Circuit Breaker:
# Amps:
Fireplace?
- Yes
- No
Woodstove/pellet stove?
- Yes
- No
Pets?
Type and breed:
Scheduled items (ie jewelry/art and $ amount):
Does HOA Provide Coverage for the Structure: (Please refer to the HOA or CC&R to see what coverage is provided for the structure under their policy)
Protection Devices Installed:
- Fire Extinguisher
- Smoke Detectors
- In home sprinkler system
- Dead Bolts
- Gated Community
- Retirement Community
- Central Burglar/Fire Alarm
- Monitoring Company
# miles to closest fire station:
Responding Fire Department:
Prior address if less than 2 years:
Mortgage company:
Loan #:
Prior Insurance Company:
# years with current company:
Current annual premium:
Liability limit:
Deductible:
Personal Property Coverage:
Medical payment:
Any claims in the last 5 years:
Date of loss:
Claim amount: $
Description:
Are you interested in any of the following if available:
- Umbrella
- Life Insurance
- Identity Theft
- Sewer/Water Backup
- Business Pursuits
- Home Day Care
- Equipment Breakdown
Name
This field is for validation purposes and should be left unchanged.

Personal Information

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