Get your asset protection quote

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

Section 1: Basic Policy Holder Info
Section 2: Coverage Desired
Section 3: Billing & Underwriter Info
Section 4: Prior Coverage & Portfolio

Basic Policy Holder Information

Policy Holder Name *

How is the property titled?

Address (Cannot be a P.O. Box) *

Example: Where will the policy be mailed?

City *

State *

Zip Code *

Is your mailing address different from above?

No Yes

Phone Number *

Cell Phone

Email *

Fax Number

Contact

Are you a licensed insurance agent? *

No Yes

Are you an Investor or Lender?

Investor Lender

Years in Business

How did you hear about us ? *

Has Applicant ever filed for bankruptcy?

No Yes

Total number of all Investor-owned property

What percent is Residential?

What percent is Commercial?

Are any of these properties mobile homes?

No Yes

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?

No Yes

COVERAGE DESIRED

Effective Date Coverage Desired

Check All Coverage Desired

Investor Owned Property

Check all coverage desired 2

Premises Liability for Investor Owned Property

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?

No Yes

Will you hold the loan on any Investor Property you sell?

No Yes

Is Forced Place Coverage desired?

No Yes

Are any properties rented?

No Yes

Please select your preferred billing cycle

Monthly Annual

Invoice billing is emailed. Would you prefer an alternate method?

No alternate method Regular Mail Fax

BILLING INFORMATION

Billing Contact Name

Billing Address

Billing Contact Email Address *

Billing Contact Phone Number

UNDERWRITING INFORMATION

Do you make physical inspections of the properties?

No Yes

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?

No Yes

i.e. Doors locked; no broken windows; windows locked

IMPORTANT:Policy requires vacant properties are properly secured.

Are vacant properties winterized?

No Yes

i.e. heat left on, pipes drained

Do you inspect the interior AND the exterior?

No Yes

Do you receive written reports in the event another party makes inspections?

No Yes

How often are inspections made?

IMPORTANT: Policy requires monthly inspections to all VACANT properties.

Do inspections include safety and physical hazards at each location?

No Yes

i.e. ENTRYWAYS, STEPS, RAILINGS - Loose boards, bricks, stones, hand railing

Are repairs made promptly to properties where a hazard to the public exists?

No Yes

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?

No Yes

Will any properties be renovated?

No Yes

Do you require contractors and subcontractors to provide proof of liability insurance prior to hiring?

No Yes

PRIOR COVERAGE / LOSS HISTORY

Do you currently have coverage elsewhere?

No Yes

Have you had any losses within the past 5 years? *

No Yes

PROPERTY LIST / PORTFOLIO

Do you have more than 8 properties to insure? *

No Yes

List of Properties

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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.

Acceptance Read

I have read and agree to the disclosure.

DISCLOSURE

I understand this policy provides coverage for manufactured and mobile homes and must be listed as such for coverage to be in place. Please be advised that rates for manufactured and mobile homes are higher. I understand that this policy excludes pollution, contamination, and seepage coverage.
I understand that physical and security inspections are required monthly for vacant properties and that I must keep these records for verification in the event of a claim.
I understand that vacant properties must be secured but not boarded up.
I understand that grass must be mowed; ice and snow removed; loose handrails, entryways, and sidewalks must be fixed upon discovery.
I understand that doors and windows must be locked and that doors or windows cannot be broken.
I understand that properties must be properly winterized including, but not limited to, having the heat remain on and pipes drained.
I understand that a property management company, owner, or trained professional is authorized to complete inspections.
I understand that this insurance provides single interest to only the named insured. The information that is provided on this application is true and factual and without material misrepresentation.
I understand that material misrepresentation or omission will invalidate the coverage.
I understand that it is my responsibility to read and comprehend the contents of this application and any subsequent policies.
I understand that this application is not a policy of insurance and no coverage, temporary or otherwise, is provided upon submission.

Get Your Asset Protection Quote

Basic Policy Holder Information