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APARTMENT BUILDING INSURANCE FORM

* = required
Contact Person:*
Phone Number:*(xxx-xxx-xxxx)
Email Address:*
Type of Business: Sole Proprietor Corporation Partnership LLC
Address:
 
City:
State:
Zip:
Fax Number:(xxx-xxx-xxxx)
Building Value:$
Building Contents Value:$
Business Income Value:$
Number of Units:
Building Square Feet:Square Feet
Number of Stories:
Basement: yes no
Number of Swimming Pools:
Does the building have
Copper Wiring:		 yes no
Year Built:(yyyy)
Construction Type: masonary masonary n/c frame
Is there an automated sprinkler: yes no
Have you reported any claims
or losses to your insurance
company within the last 3 years:		 yes no
Roof type composition: shingle tile other
Roof Age:years
Current Insurer:
How long have you been
insured with this company:		 years
Policy Renewal Date:(mm/dd/yyyy)
Approximate Current Premium:$
Amount of Coverage:$
Deductible:$
 
 
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