Office Building / Shopping Center Quote



Basic Information
Name
Address
City, State, Zip Code
Telephone
Cell
Fax
Email
Best time to call
Please send quote via	Email Fax Mail Call Me
How did you hear about us?


Current Policy Information (Questions for all types of property)
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:
Property Limit-- Building Coverage Limit Requested
Annual Rental Income
Deductible
Liability Limit


Property Information
Property Type
Property Address
City, State, Zip code
How long have you owned this building?
Managed by
Approx year built
Total # of Offices or Tenants
Any Anchor Tenants ie: Raphs, Food for Less, etc.?	Yes No
Any Restaurants?	Yes No If yes, # of Restaurants:
Do Restaurants have Fire Safety (ansul system)?	Yes No If yes, what type? Wet Dry
Total # of Buildings
Total # of Stories
Approx Total Square Feet

Location Information
Type of Construction
Type of Parking

Type of Plumbing:
When was the Plumbing system updated?
Type of Electrical
When was the Electrical system updated?
Type of Roof
When was the Roof last replaced?
Type of Heating
When was the Heating system updated?
Do all leases contain a Hold Harmless Clause?	Yes No
Do you provide any Security Service for the property?	Yes No
Is the location:	Fully Sprinklered Partially Sprinklered Parking Only None
Note: For shopping centers and business parks a Tenant List will be required indicating square footage occupied by each tenants. Please fax to (909) 606-2420 or mail, email to contact@fullerins.com.

Limits Desired



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.