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Condominium / Cooperative Evaluation
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Insured 1 - First Name
What is your first name?
Insured 1 - Last Name
What is your last name?
This field is hidden when viewing the form
Name
What is your full name?
Preferred Phone Number
What is your preferred phone number?
Primary Email
What is your email address?
Alarm System
Did you install an alarm system in your condominium / cooperative in the last 12 months?
Yes
No
Alarm components
Which components are included in your alarm system? Many components of centrally monitored alarm systems are eligible for discounts on your condo/co-op insurance.
Fire/Smoke
Burglar/Motion
Low Temperature
Water Leak Detection
Cellular Backup
Explosive Gas Leak Detection
Other
Alarm components other
What other alarm components does your alarm system have?
Risk Management
What risk management strategies do you employ at this residence?
Permanently Installed Back-up Generator
Water flow monitor and automatic water shut-off valve
Indoor sprinkler system
Seismic shut-off valve
Other
Other Risk Management Strategies
What other risk management strategies do you employ?
Trust / LLC
Is your Condominium/Cooperative owned by a trust, LLC or other legal entity?
Yes
No
Entity name
Please provide the name of the trust, LLC or other legal entity your condo/co-op is owned by.
Renovations
Any updates/renovations/additions planned or recently completed?
Yes
No
About renovations
Please tell us about the renovations.
Home updates
Have you updated any of these?
Electrical
Plumbing
Heating
Roof
No updates
Other
Updates Other
What other updates have you done?
Home business
Any business conducted in your condo/co-op?
Yes
No
Business description
Please tell us about your business.
Valuables acquired
Any significant acquisitions in the past 12 months that we should know about?
Jewelry
Fine Art
Silverware
Wine
Antiques
Firearms
Collectibles
Other
Other Valuables
What other type of valuables did you acquire?
Appraisals
Do you have any new appraisals for your valuables that you can upload to us?
Yes
No
Appraisal upload
Feel free to upload your appraisals to us.
Drop files here or
Select files
Max. file size: 128 MB.
Occupancy
Has the occupancy status of your condo/co-op changed?
Yes
No
Occupancy changed
How has the occupancy of your condo/co-op changed?
Renting to a long term tenant
Renting to a short term tenant (by the day, week or month)
Unoccupied for greater than 30 days
Unoccupied and for sale
Other
Occupancy other
What is the occupancy of this condo/co-op?
Flood insurance?
Would you like to discuss obtaining new flood coverage or higher flood coverage limits for your condo/co-op?
Yes
No
Anything else?
Anything else you want to discuss regarding your condominium/cooperative insurance?
Consent
*
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.
I agree
Gates Skene
601-968-0256
https://www.rossandyerger.com/private-client-group
gskene@rossandyerger.com
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