* Type of Dwelling: Condo House Townhouse Renters
Risk-Address: Primary Dwelling
Mailing Address (If different than Risk Location):
* Dwelling Limit / Additions and Alterations:
If new purchase when will home be occupied?
* Is the home currently under Renovation or Construction? Yes No
* If NO, are there any plans for renovation or construction within the next twelve months? Yes No
* Contents / Personal Property:
* Liability: * Deductible:
No (Hours worked 20 or more)
No (Hours worked 10 or more)
Wind and Hail - Choose either a flat or % deductible option
All Other Perils - Choose either a flat or % deductible option
* Is this the Primary Residence: Yes No
* Is this a Secondary Residence: Yes No * Secondary Residence cannot be written without a qualifying primary home.
If Yes to Secondary, is it Rented to Others: Yes
* Total Square Footage:
* Number of Stories:
* Year Built (yyyy):
If more than 30 yrs. or older please indicate any recent updates/upgrades to plumbing/electrical/roof /etc.
Special features of the home for calculation of the replacement cost?
Built in cabinetry? Counter types? Fixture types? Customized or specialized rooms? (fitness center, home theater, etc.)
For California homes: If home was built before 1945, has it been retrofitted? Yes No
Year the California home was retrofitted (yyyy):
Distance To Brush (California):
1FT - 499FT
500FT - 999FT
1000FT - 2499FT
2500FT - 4999FT
Tar and Gravel
Basement Finished / Unfinished:
PROTECTION: Homes must be within 1,000 feet of a fire hydrant and within 5 miles of a fire station to qualify for our preferred rates.