Management Company Name/Self-Managed*
Manager/Requestor’s Name*
Manager/Requestor’s Email*
Manager/Requestor’s Phone Number*
Current Policy Expiration Date*
Current Insurance Carrier (not agent) for Property and General Liability*?
Association Name*
Address located within the Association*
City*
State* —Please choose an option— Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip*
County*
Type of Community*
Total Number of Members/Units*
Total Property Value of the Association*
Year Built/Year the Association was Incorporated*
If Building is over 20 years, please provide year of updates for electrical, plumbing, A/C & Heating:
Any major roof updates/replacements in the past 10 years? * —Please choose an option— Yes No
Number of Buildings*
Number of stories per building*
Construction Type of Buildings* —Please choose an option— Frame Concrete/Steel
Total Square Footage of all Buildings
Type of Building Wiring* —Please choose an option— Aluminum Copper Aluminum Pigtail
Number of Pools*
Any Diving Boards/Slides* —Please choose an option— Yes No
How many playgrounds or sports courts?*
What Common Outdoor Property is this Association Responsible for Insuring*: Fences / Retaining Walls Sports Courts Tot Lots / Playgrounds Gazebo Monuments / Signs Common Area Lighting Gates, Boat Docks Mail Kiosks Fountains Flag Poles Sprinkler Systems Other
Number of Ponds or Retention Ponds (holding water at least 90% of the time)*
Number of Lakes*
Are there Sprinklers inside the Buildings* —Please choose an option— Yes No
If yes, what percentage of the buildings are sprinklered?
Are there Hardwired Smoke Detectors in the Buildings —Please choose an option— Yes No
Are there Fire Alarms in the Buildings —Please choose an option— Yes No
Any Security Guards on Premises* —Please choose an option— Yes No
If so, are they Armed —Please choose an option— Yes No
Percentage of Owner Occupancy (versus tenants)
Any Commercial/Retail Exposure within the Association* —Please choose an option— Yes No
Any Golf Course Exposure that the Association is responsible for* —Please choose an option— Yes No
Any Beach Exposure? * —Please choose an option— Yes No
Is Association located in a FEMA deemed (high-hazard) Flood or Earthquake Zone? —Please choose an option— Yes No
Any Unusual Exposures (Equestrian, landfills/dumps, underground storage tanks, airports, medical facilities, bike trails, leasing of machinery or watercrafts, etc.) that the Association is responsible for: *
Any Property, Liability, Crime or D&O losses in the past 5 years? * —Please choose an option— Yes No
Does the association want Workers Comp coverage? —Please choose an option— Yes No
Does the association want Crime / Fidelity Coverage? —Please choose an option— Yes No
If so, what is the desired Crime / Fidelity Limit
Does the Association own any Automobiles
We encourage you to submit any insurance documents that may pertain to your quote; doing so will help in the accuracy and speed of your request. Please save document(s) to your computer, choose the appropriate file(s) and submit below. (5 Year Loss Runs, Recent Reserve Study, Current Certificate of Insurance, Current Appraisal, Current Insurance Declaration Pages, Current Policy, etc.)
Insurance Document 1
Insurance Document 2
Insurance Document 3
