Landlord / Dwelling Fire Insurance Quote We would like to provide you with a free, no-obligation landlord insurance quote for a dwelling fire policy. Please complete as much information as possible for the most accurate quote. This information will be kept confidential and used for quote purposes only. This form is hosted on a secure server using SSL technology.

 

Applicant Information Primary Insured Full Name (First, Last) Date of Birth Phone Number Email Address Occupation How long at current job? Mailing Address City State Zip Code Do you own other rental properties? If yes, how many rental units do you own? Y   N

Property Information Property Address City State Zip Code Year Built Square Footage (excl. basement/garage if applicable) Number of Units Number of Stories Select One 1 Unit 2 Units 3 Units 4 Units Select One 1 Story 1.5 Story 2 Story Split Level Bi-Level Other Property Type Construction Type Foundation Type Select One Single Family Townhome End Unit Townhome Interior Unit Duplex Triplex Fourplex Condo Other Select One Frame Stucco Vinyl Siding Brick Veneer Masonry Other Select One Basement Crawl Space Slab Other Roof Type Roof Age Garage Select One Architectural Shingle 3-Tab Shingle Metal Tile/Slate Other Select One None 1 Car Attached 2 Car Attached Detached Built-In Carport

Occupancy Details Occupancy Type How long has the property been tenant occupied? Select One Tenant Occupied Vacant Seasonal Under Renovation Owner Occupied Lease Type Is the property currently vacant? If vacant, how long has it been vacant? Select One Long-term Lease (12+ months) Short-term Rental Airbnb/VRBO/etc. Student Housing No Current Lease Y   N Any occupancy gap during the last 12 months? If yes, explain Y   N

Rental / Landlord Details Monthly Rental Income Annual Rental Income Lease Type: Select One Written lease Month-to-month Who manages the property? Name of Property Management Company (if applicable) Is the property titled in an LLC? Select One Self-Managed Property Management Company Y   N

Current Insurance Information Current Insurance Company Policy Expiration Date Current Premium (optional) $ Has property insurance been cancelled, declined, or non-renewed in the last 5 years? If yes, explain Y   N Number of property losses in the last 5 years Loss details Y   N

Coverage Requested Requested Effective Date Desired Dwelling Coverage Amount Desired Deductible $ Select One $1,000 $2,500 $5,000 Other Personal Property Coverage needed for landlord-owned items? Loss of Rents Coverage needed? Liability Limit Y   N Y   N Select One $100,000 $300,000 $500,000 $1,000,000

Property Updates / Condition Year Roof Updated Year Plumbing Updated Year Electrical Updated Year Heating Updated Primary Heating System Any knob and tube wiring? Select One Gas/Propane Hot Water Gas/Propane Forced Air Electric/Gas Heat Pump Electric Baseboard Oil Tank (Underground) Oil Tank (Above Ground) Other Y   N Any aluminum wiring? Any unrepaired damage? If yes, explain unrepaired damage Y   N Y   N

Safety Features Smoke Detectors Installed? Fire Extinguishers on Premises? Security Alarm? Y   N Y   N Select One Monitored Not Monitored None Fire Alarm? Fire Sprinkler System? Deadbolt Locks Installed? Select One Monitored Not Monitored None Y   N Y   N

Additional Risk Information Any business conducted on premises? Any short-term rental activity (Airbnb/VRBO/etc.)? Any open code violations? Y   N Y   N Y   N Swimming Pool? Pool Fenced? Wood Burning Stove? Select One None Above Ground In Ground Select One Yes No Not Applicable Y   N

Comments / Additional Information Please provide any additional comments for this quote request

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