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Dwelling Fire/Landlord Policy
Dwelling Fire/Landlord Policy
Name/Business Name the Property Is In
Primary Contact Name
Primary Contact Address
Primary Contact Date of Birth
MM slash DD slash YYYY
Primary Contact Email
Primary Contact Phone
Texting
*
I consent to receive text messages at the provided number
I opt out of text messages
Insured Location Address
Mailing Address of Property Owner
EIN (if applicable)
Dwelling Coverage Amount
How much do you want the property insured for?
Year of Roof
Year of Central Heating System
Year of Plumbing
Year of Electrical
Is the property rented on a 12 month basis or shorter term such as Air BNB or similar service?
How much are annual rents?
Is there a property manager?
Yes
No
Is the property currently occupied?
Yes
No
Is there a pet policy enforced?
Yes
No
Are any of these breeds excluded?
Akita (include hybrid/mixes)
American Staffordshire Terrier (include hybrid/mixes)
Bullmastiff (include hybrid/mixes)
Chow Chow (include hybrid/mixes)
Doberman Pincher (include hybrid/mixes)
German Shepherd (include hybrid/mixes)
Pit Bull (include hybrid/mixes)
Presa Canario (include hybrid/mixes)
Rottweiler (include hybrid/mixes)
Wolf Hybrid (include hybrid/mixes)
Other Breed
Other Breed
Do you require tenants to have liability insurance (renters insurance)?
Yes
No
Is the property currently insured or new purchase?
Currently Insured
New Purchase
What is the closing date?
MM slash DD slash YYYY
If Purchase provide the following:
Purchase Price
Expected occupancy date
Would you like coverage for underground service lines
Yes
No
If yes, 10,000 or 20,000 or max allowed?
Would you like Water back up coverage
Yes
No
If yes, please choose dwelling amount
$5,000
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
$100,000
Would you like equipment breakdown?
Yes
No
Do you insure any other items such as jewelry, furs, gold or other items listed on your policy.
Do you have a mortgage on the property?
Yes
No
List
Will the insurance premium be escrowed?
Yes
No
Is there a pool, trampoline, or other increased hazard on the property?
Yes
No
Additional Comments
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