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What is your first name? *
What is your first name? *
What is your last name? *
What is your last name? *
What is your email address? *
What is your email address? *
What is your phone number? *
What is your phone number? *
What is the address where the solar panels are located? *
What is the address where the solar panels are located? *
Street Address
Address Line 2
City
State
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Ohio
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Texas
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U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Solar Panel Information
Where are the solar panels located? (Check all that apply)
Where are the solar panels located? (Check all that apply)
Roof of the Main Dwelling
Roof of a Secondary Structure
Ground Mounted
Other
Please enter the other location of the solar panels.
Please enter the other location of the solar panels.
What is the age of your roof?
What is the age of your roof?
Please select your roof type:
Please select your roof type:
Asphalt Shingle
Architectural Shingle
Wood Shingle
Metal Roof
Flat Roof
Rubber Roof
Cement Tile
Clay Tile
Other
Please provide a description of your roof type:
Please provide a description of your roof type:
Do you own or lease the solar panels?
Do you own or lease the solar panels?
Own
Lease
Are you responsible for insuring the panels?
Are you responsible for insuring the panels?
Yes
No
What is/are the use(s) for the power generated by the solar panels? (Check all that apply)
What is/are the use(s) for the power generated by the solar panels? (Check all that apply)
Home Power Generation
Pool Heating
Other
Please enter the other use(s) for the power generated by the solar panels.
Please enter the other use(s) for the power generated by the solar panels.
How many solar panels are there?
How many solar panels are there?
What is the value of the solar panels?
*
What is the value of the solar panels?
Have you obtained an engineering report to determine if your roof can support the added weight?
Have you obtained an engineering report to determine if your roof can support the added weight?
Yes
No
Please upload a copy of the engineering report, if available.
Please upload a copy of the engineering report, if available.
Max. file size: 128 MB.
Please select the security protections you have in place.
Please select the security protections you have in place.
Fencing
Gate
Video Surveillance
None
Other
Please enter the other security precautions you have in place.
Please enter the other security precautions you have in place.
Are the solar panels rated to withstand hail?
Are the solar panels rated to withstand hail?
Yes
No
Not sure
What diameter hail are the solar panels able to withstand?
What diameter hail are the solar panels able to withstand?
Are the solar panels rated to withstand high winds and hurricanes?
Are the solar panels rated to withstand high winds and hurricanes?
Yes
No
Not sure
What wind speed are the solar panels able to withstand?
What wind speed are the solar panels able to withstand?
Is there a preventative maintenance and service program in place that complies with the manufacturer's requirements?
Is there a preventative maintenance and service program in place that complies with the manufacturer's requirements?
Yes
No
Not sure
Are the solar panels UL 1703 certified? (UL 1703 is the Standard for Safety of Flat Panel Photovoltaic Modules and Panels)
Are the solar panels UL 1703 certified? (UL 1703 is the Standard for Safety of Flat Panel Photovoltaic Modules and Panels)
Yes
No
Not sure
What is the name of the installation contractor?
What is the name of the installation contractor?
How many years experience does the contractor have installing solar panels?
How many years experience does the contractor have installing solar panels?
Is the contractor certified by the manufacturer?
Is the contractor certified by the manufacturer?
Yes
No
Not sure
Does your home have a battery energy storage system in place (BESS)?
Does your home have a battery energy storage system in place (BESS)?
Yes
No
Battery Energy Storage System
What is the storage capacity?
What is the storage capacity?
What type of battery energy storage system do you have?
What type of battery energy storage system do you have?
Lead Acid
Lithium Ion Battery Technology
Not sure
Where is the battery (BESS) stored?
Where is the battery (BESS) stored?
Indoors
In a garage
Outdoors
What fire protections are in place?
What fire protections are in place?
How far from the home are the solar panels located?
How far from the home are the solar panels located?
Is there a dike around the equipment?
Is there a dike around the equipment?
Yes
No
What is the use of the stored energy?
What is the use of the stored energy?
Personal Use
Selling it to the grid
Documents and Comments
Please use this field to upload any relevant insurance documents.
Please use this field to upload any relevant insurance documents.
Drop files here or
Select files
Max. file size: 128 MB, Max. files: 10.
Please enter any additional remarks in the space below.
Please enter any additional remarks in the space below.
How did you hear about us?
How did you hear about us?
Current customer
Referred by...
Google search
Agency's website
Email newsletter
Facebook
Instagram
Twitter
Other
Please share who referred you to us.
Please share who referred you to us.
Please share what you typed into Google.
Please share what you typed into Google.
Please share how you heard about us.
Please share how you heard about us.
<font size="2" color="gray">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.
*
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*
Cecilia Rivera
860-868-7361
http://ericsoninsurance.com/
Cecilia_Rivera@ajg.com
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