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Construction
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Name of Insured
*
e.g. John Doe, or ABC Company, or John Doe & Susan Smith
Mailing Address
Street Address
*
City
*
State/Territory
*
Zip
*
Home Phone
Work Phone
Cell Phone
Email Address
*
Occupation
Is this application for a Personal or a Business policy?
*
Personal
Business
Commencement Date
Year Built
Date Purchased
Square Footage
Building Area (sqft)
Porches/Decks Area (sqft)
Property Address - Including City and Zip Code
GPS Coordinates
Latitude
°N
Longitude
°W
Locate
Lienholders / Mortgagors
Click to Add Lienholder/Mortgagor
Construction of Walls
Select an option
Reinforced Concrete
Reinforced Concrete Block
Hollow Concrete Block
Brick or Stone
3-D Panel
Wood Stud
Steel Stud
Other
Alterations & Renovations
Have there been any alterations, additions, or renovations to the building?
*
Yes
No
Has this home sustained any loss, damage, or liability in last 5 years?
*
Yes
No
Has any insurer declined or cancelled insurance or imposed special conditions?
*
Yes
No
Roof Details
Roof Structure
Select an option
Reinforced concrete
Exposed Beam
Wood Rafter (open system for corrugated metal)
Wood Trusses
Steel Rafters
Steel joists with steel decking
Roof Structure Anchor System
Select an option
Hurricane clips (secured to bond beam)
Re-bar from slab through rafter end
None
Other
Laths or Purlins
Select an option
N/A
Not more than 24" apart
More than 24" apart
Nailed or screwed to each rafter
Roof Cover
Select an option
Aluminum or corrugated metal
Painted
Standing seam
Enamel Finish
Clay Tile
Plastic Tile
Membrane Coating
Composition Shingle
Other
Roof Cover Fastenings
Select an option
N/A
Nails
Screws
Nails & Screws
Staples
Other
Intervals Between Fastenings
Select an option
N/A
Less than 8"
More than 8"
Roof Overhang
Select an option
None
2'
2'-4'
Over 4'
Fire & Other Safety
Electrical: Rewired?
Yes
No
Fire extinguishers?
Yes
No
Smoke detectors?
Yes
No
Distance to fire department (Miles)
Other water sources
Cistern
Pool
Other
Fire detection/Alarm system?
Yes
No
Burglar Alarm System?
Yes
No
Exterior Opening Protection
Hurricane Shutters
Full
Partial
None
Shutter Type
Roof type steel
Hinged Wood (permanent)
Steel Panels (portable)
Anchor bolts to receive plywood
Other
Impact Glass
Yes
No
Iron Grill Work
Yes
No
Aluminum “Miami” louvers
Yes
No
If none of the above, please explain how exterior openings will be protected in the event of a hurricane
Contents whilst in the home
Contents whilst in the home
Please provide estimated replacement costs for the following categories of high risk items.
TV, Audio & Video Equipment
$
Computer Equipment
$
Jewelry & Watches
$
Pictures, works of art
$
Photographic equipment
$
All Other Contents Cost
$
If the replacement cost of any High-Risk Item exceeds > $2,500, list item(s) and value(s) below:
Description
Replacement Cost
$
Click to Add High Risk Item
Current photos of the building (inside and out) will be required for quoting. A replacement cost appraisal is best.
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