Elementor #3943 - Urban Advantage

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Apartment Quote

Please complete the following questions

Agency Name (If applicable)

Agency Email

Agency Phone Number (If applicable)

Business Entity Type

Individual

Partnership

Joint Venture

Limited Liability Corporation (LLC)

Corporation

Other

Name / Business Name / DBA

First Name

Last Name

Property Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Insured Phone Number

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Number of Years in Business

Effective Date

Liability Limit

$300.000

$500,000

$1,000,0000

$2,000,000

Medical Expenses

Excluded

$5,000

$10,000

Liability Property Damage Deductible

$250

$500

$1,000

$2,500

Liability Property Damage Deductible Type

Per Claim

Per Occurrence

Liability Bodily Injury

None

$500

$1,000

$1,500

$2,500

Annual Rental Receipts Amount

Number of Employees

Will you be selecting Hired and/or Non-owned Auto coverage for this prospect?

Yes

No

Will you be selecting Hired and/or Non-owned Auto coverage for this prospect?

Yes

No

Is the risk within 1000 feet of a fire hydrant or other approved?

Yes

No

How Many road miles is the risk from a responding fire station?

Within 5 road miles from a responding fire station

More than 5 but less than 7 road miles from a responding fire station

Greater than 7 road miles from a responding fire station

I don’t know

Occupancy

Non-owner occupied building / lessor's risk

Owner occupied building - less than 10%

Owner occupied building - more than 10%

Tenant

Building Type

Stand-alone building

Located in strip mall

Located in enclosed mall

Construction Type

Frame

Joisted Masonry

Non-Combustible

Masonry Non-Combustible

Modified Fire Resistive

Year Built

Year Roof was last completely replaces or resurface

Year of Plumping Update

Year of Heating Update

Number of Stories

Roof Type

Concrete

Flat Roof- Asphalt

Flat Roof – PVC/TPO

Metal

Shingle-Asphalt/Fiberglass

Slate/Tile

Wood

Unknown/Other

Total Building Square Footage

Total Square Footage occupied by the insured

Number of Residential Units

Automatic Sprinkler System (100% of Building)

Yes

No

Automatic Fire Alarm

None

Central Station

Local Alarm

Automatic Burglar Alarm

None

Central

Police Station

Security Cameras

Yes

No

Has the property undergone lead abatement procedures?

Yes

No

What percentage of the building is vacant?

What percentage of units are rented to students (including undergraduate, graduate and medical?

Do all units have two means of egress?

Yes

No

Do all units have smoke detectors in the sleeping areas?

Yes

No

Are common hallway smoke detectors hard wired?

Yes

No

N/A

Is the building, location(s) and/or surrounding areas currently undergoing any renovations or new construction or are any renovations or new construction planned?

Yes

No

Does this building have any knob and tube wiring?

Yes

No

Does this building have any Federal Pacific (FPE) Stab-Loc or Zinsco electrical panels?

Yes

No

Is this building registered as a historical building on the National Register of Historical Places?

Yes

No

Does the prospects lease agreements require their tenants to carry liability insurance?

Yes

No

Does the prospect have a policy in place, which is enforced by the prospects, prohibiting grills on decks?

Yes

No

Building Coverage Limit

Building Valuation

Replacement Cost

Actual Cash Value

Functional Building Valuation

Business Personal Property Limit

Business Personal Property Seasonal Increase Percent

Business Personal Property Valuation

Replacement Cost

Will you be submitting to us additional lines of insurance for this prospect?

Yes

No

During the last five years, has any applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson or any other arson-related crime in connection with this or any other property?

Yes

No

Has the prospect had a foreclosure, repossession, bankruptcy, judgment or tax lien, business failure or any litigation during the past five (5) years?

Yes

No

Have there been any past losses or claims relating to sexual abuse or molestation allegations, discrimination or negligent hiring?

Yes

No

Has the prospect had any losses in the past 4 years (current policy and prior 3 years)? If "Yes", please provide details of loss on "Additional Comments" field below.

Yes

No

Has any policy or coverage been cancelled or non-renewed during the prior three (3) years for other than non-payment of premium?

Yes

No

I understand that Urban Advantage Insurance will be contacting the insured for additional information. Please let us know if you would like to be notified, before reaching out to the insured, in the additional comments below.

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