Apartment 4+ and Condo Quote

Basic Information
Name
Address
City, State, Zip Code
Telephone
Cell Phone
Fax
Email
Best time to call
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How did you hear about us?


Type of Property
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Property Information
Property Address
City, State, Zip code
How long have you owned this building?
Managed by
Approx year built
Total # of Units, Offices, or Rental spaces
Total # of Buildings
Total # of Stories
Approx Total Square Feet

Location Information
1. Type of Construction
2. Type of Parking

3. Type of Plumbing:
When was the Plumbing system updated?	(Bldgs over 40 yrs old)
4. Type of Electrical	Any Aluminum wiring? Yes No
When was the Electrical system updated?	(Bldgs over 40 yrs old)
5. Type of Roof
When was the Roof last replaced?	(Bldgs over 30 yrs old)
6. Type of Heating
When was the Heating system updated?	(Bldgs over 40 yrs old)
7. If Condo, what % of units are owner occupied?
8. How many Smoke Detectors per unit?
(a) Smoke Detectors are
(b) Is a maintenance log kept?	Yes No
9. Is the location Sprinklered?
10. How many Elevators
11. Do any windows have Security Bars?	Yes No If yes, are all equiped with Quick Releases? Yes No

12. Balcony/Handrails (Railings)?	Horizontal Vertical None
	Openings:
13. Do doors have deadbolts locks?	Yes No
14. Is there Exterior Lighting provided for all walkways, stairs and parking areas?	Yes No
15. Are there any enclosed stairs or hallways?	Yes No
(a) Emergency lighting in all common areas including halls, stairs & lobby areas?	Yes No
(b) Illuminated exit signs provided?	Yes No
16. Any children playgrounds on premisis?	Yes No
17. Is there a gym or additional recreational facilities?	Yes No
18. Laundry room on premises?	Yes No
19. Are there any Pools, Jacuzzies, or Spas on premises?	Yes No
(a) Is pool separately fenced with self-closing, latching gate?	Yes No Fence Height:
(b) Are depths clearly marked on top edge of pool?	Yes No
(c) Diving Board of Slide?	Yes No
(d) Are rules clearly posted and life saving equipment accessible?	Yes No
(e) Is there a service/maintenance schedule for pool, jacuzzi or spa?	Yes No
20. Does complex have any streams or ponds?	Yes No If yes, depth of water:
21. Any units vacant?	Yes No 21. If yes # of units vacant:
22. What % of occupants fall into the following categories?	(a) Subsidized: (b) Student: (c) Seasonal:
23. Is property designated for Senior housing?	Yes No
24. Do shower doors have safety glass?	Yes No
25. Is there ongoing or planned construction or remodeling, other than normal maintenance?	Yes No If yes, estimated cost:
26. How many tenants have been evicted in last 3-years?
27. Are there any plans to evict anyone within the next 90 days?	Yes No
28. Any fire losses at this or other property or business within the past 20 years?	Yes No


Current Policy Information
Current Insurance Company
Current Policy Expiration Date
Number of Insurance Claims within the past 3 years
Are you being cancelled or non-renewed by your present carrier?	Yes No If yes, reason:


Coverage Limits Desired
Property Limit-- Building Coverage Limit Requested
Annual Rental Income
Deductible
Liability Limit

Additional Comments or Questions:

* Please note coverage will not be written nor bound prior to confirmation from Fuller Insurance Agency. The information you provide is sent to our office and an agent will contact you directly with a quote.