Condo Association Quote Request

Contact Information

Contact Name:
Contact Address 1:
Contact Address 2:
Contact City, State:	,
Contact Zip
Contact Phone:
Contact Fax:
Contact Email:

Business Name:
Business Address 1:
Business Address 2:
Business City, State:	,
Business Zip
Business Phone:
Business Fax:
Business Email:

Building and Property Information

Nature of your business:
Type:	Commercial Residential Homeowners Association Condo Association
Number of Units:			Numbers of Buildings:
Other business names:	Yes No		Years Under Current Name:
Any unusual exposures:
Construction Type:			Nunber of stories:
Type of roof covering:

Claims Information:
Claims or losses in last 5 years:	Yes No
Please explain:	Date, amount paid and description of each loss or claim.

Coverage Information:
Current insurance company:			Current Premium
Liability limit requested?			Building limit requested?
Building deductible requested?			Business contents limit requested?
Contents deductible requested?			Loss of income requested?

Miscellaneous Information
Current Policy Expiration:
Any questions, comments or additional coverage required?

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