Apartment (Mixed Use) Insurance Quote Request Form printable pdf download

Apartment (Mixed Use) Insurance Quote Request Form

Fax to 925-945-8802

*Building Owner Name :_______________________________

*Mailing Address: ______________________________________________________________

*Mailing City/State/Zip: _________________________________________________________

Property Address

*Street Address: _______________________________________________________________

*City____________________________*State_______*Zip Code______________

Property Information

*Construction Type:___________________________

*Year Built: _____________________ *Number of Buildings ______________________

*Number of Units: ___________________

*Does any building contain 16 or more units? Y / N

*Number of Stories : _________

*Senior Living 55+ : Y / N

*Restaurant Type : (If Any): __________________________________________

Replacement Cost Estimator

*Total Square Footage: ___________ *Quality of Construction: ________________________

*Number of Outside Stairwells: __________*Square Footage of Garage(s): _______________

*Number of Bathrooms in entire building: ___________

*Central Air or Heat? Y / N

*Estimate Replacement Cost: $______________________

Coverage Information

*Building Coverage Amount:_________________________

*Business Personal Property: ______________________max: 20% Building Coverage

*Deductible: ______________

Apartment (Mixed Use) Insurance Quote Request Form