What is your first name?*
What is your last name?*
What is your email address?*
What is your phone number?*
Please select the situation that is dictating the need for this information.
Please provide a brief description of the situation dictating the need for this information.
Do you own or lease the building?
What is the legal name of the owner of the building?*
What is the address of the building for which you are providing information?*
Please select the building's construction type.
Please select the term that best describes the condition of the building.
Please select the term that best describes the quality of the building.
What construction material was used for the walls?
How old is the heating system?
What type of heating system does the building have?
How old is the cooling system?
What type of cooling system does the building have?
What type of fuel does the heating/AC system utilize?
Does the building have a basement?
Does the building have an attic/penthouse?
What year was the building built?
Has the building been renovated since its was built?
What year was the building renovated?
What is the floor height? (In feet)
How many floors/stories does the building have?
What is the total square footage of the building?
What is the value of the building?
What is the value of the contents within the building?
Is the building vacant?
What is the occupancy classification of the building?
Please provide a description of the occupancy of the building.
Is the building equipped with fire extinguishers?
Is the building's inspection current?
Does the building have a manual pull box fire alarm system?
Is the manual pull box fire alarm being monitored/supervised?
Does the building have sprinkler protection?
What percentage of the building is sprinklered?
Is the sprinkler system being monitored/supervised?
Does the building have smoke/heat detectors?
Are the smoke/heat detectors being monitored/supervised?
Does the building have a security system?
Is the security system being monitored/supervised?
Does the building have fire hydrants within 1,001 feet?
Does the building have a fire department within five miles?
Is the building located in a severe hazard flood zone? (I.e. A, V, etc.)
Is the building located in a high wind prone area? (I.e. coastal)
Does the building have any special hazards that could impact it? (I.e. Earthquake, etc.)
Please provide a brief description of the special hazards that could impact this building.
Please select the term that best describes this building's exposure to risk of physical damage.
Documents and Comments
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Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.
Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.