Asset protection quote “MINIMUM OF FIVE PROPERTIES REQUIRED to issue a policy.” This Is Not A Policy Of Insurance. This is an application to receive an Asset Protection Quote. This application provides NO COVERAGE whatsoever.  To fully understand your needs, a representative will contact you within 1 business day to discuss your application.

Is your mailing address different from above?
Are you an Investor or Lender?
Has Applicant ever filed for bankruptcy?
Are any of these properties mobile homes?
Are you a licensed insurance agent? * *

IMPORTANT: This policy provides coverage for Mfg. & Mobile Homes but must be listed as such for coverage to be in place. Be advised, Mfg. & Mobile Home have a higher deductible and rates.

Do any locations have a known pollution exposure?

COVERAGE DESIRED

PREMISES LIABILITY REFUSAL AFFIRMATION

By checking the below checkbox, I affirm that

I understand that premises liability has been

offered to me and I have elected NOT to have this coverage.

I affirm

STANDARD DEDUCTIBLES: $5,000

Would you like a different deductible?
Are any properties rented?
Please select your preferred billing cycle
Will you hold the loan on any Investor Property you sell?
Is Forced Place Coverage desired?
Invoice billing is emailed. Would you prefer an alternate method?

BILLING INFORMATION

UNDERWRITING INFORMATION

Do you make physical inspections of the properties?

IMPORTANT: Policy requires monthly inspections to all VACANT properties. Inspection reports should be immediate upon property becoming vacant and you secure the location. This report should contain the date the property was secured, receipt for locks being changed and the condition along with pictures of the property at the time of that inspection. These monthly inspection reports are created and maintained by you.

Are vacant properties properly secured?
i.e. Doors locked; no broken windows; windows locked

IMPORTANT: Policy requires vacant properties are properly secured.

Are vacant properties winterized?
i.e. heat left on, pipes drained
Do you receive written reports in the event another party makes inspections?
Do you inspect the interior AND the exterior?

IMPORTANT: Policy requires monthly inspections to all VACANT properties.

Do inspections include safety and physical hazards at each location?
i.e. ENTRYWAYS, STEPS, RAILINGS - Loose boards, bricks, stones, hand railing
Are repairs made promptly to properties where a hazard to the public exists?
i.e. SIDEWALKS - uneven, cracked, tree root growth

IMPORTANT: Policy requires vacant properties are properly secured.

Is any outside firm contracted to make inspection / manage property?
Will any properties be renovated?
Do you require contractors and subcontractors to provide proof of liability insurance prior to hiring?

Asset protection quote “MINIMUM OF FIVE PROPERTIES REQUIRED to issue a policy.” This Is Not A Policy Of Insurance. This is an application to receive an Asset Protection Quote. This application provides NO COVERAGE whatsoever.  To fully understand your needs, a representative will contact you within 1 business day to discuss your application.

* = Required Field

PRIOR COVERAGE / LOSS HISTORY

Do you have more than 8 properties to insure? *
Max file size:5mb

PROPERTY LIST / PORTFOLIO

Do you currently have coverage elsewhere?
Have you had any losses within the past 5 years? * *

IMPORTANT:
This insurance provides single interest only to the named insured. The signed application warrants all information provided on this application is true and factual. Signed applicant understands that it is their responsibility to read and comprehend the contents of this application, and that any material misrepresentation or omission will invalidate coverage.

THIS IS NOT A POLICY OF INSURANCE. THIS IS AN APPLICATION TO RECEIVE A QUOTE AND PROVIDES NO COVERAGE WHATSOEVER.