Condo Association Name:

First Name:

Last Name:

Phone Number:

Fax:

Email:

Website URL:

Type of Business:

Sole Proprietor Corporation Parternship LLC

Policy Expiration Date :

Building Value/Coverage Amount:

Building Contents Amount:

Number of Units:

Number of Buildings:

How many Square feet is the building? [Under air, living area only]:

How many Stories is the unit?

1 2 3

What is the Year Built?

Note: If you are unsure of any of these questions, don't worry about it, we will figure it out for you. Please keep going you are almost done.

Have there been in any claims within the last three years?

yes no

If yes, please describe:

Current Insurance Company:

Total Current Premium for All Policies:

Have you had an appraisal completed within the last 18 months?

yes no

Is there mortgage?

yes no

Do you Escrow your insurance?

yes no

Do you purchase windstorm coverage?

yes no

Is the windstorm/hurricane coverage insured with Citizens?

yes no

Have you had a Windstorm Inspection completed?

yes no

Address:

City:

State:

Zip:

Note: The following fields are not required, however, the more information that you provide the more competitive and accurate the quotes will be.

Construction Type:

Frame Joisted Masonry Masonry non-combustible Fire Resistive{AAA}Buildingse

Roof Type:

shingle tile flat metal flat concrete tar & gravel

Roof Age:

Plumbing date

Electrical date

Heating date

Roof date

How many swimming pools?

Other Recreation: :

Spa

Exercise Room

Tennis Courts

Clubhouse

Playground

Boat Docks/Slips

Does the building have Copper wiring?

yes no

Are there automated sprinklers?

yes no

Are there smoke detectors in each unit?

yes no

Are the smoke detectors hardwired or battery?

hardwired battery

Are there security guards?

yes no

Is the Building Gated ?

yes no

yes no

Company Name:

Phone:

e-mail: