|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Preferred Method of Contact: |
|
| This quote request is for detached homes (1 or 2 family). |
| Available remediation documents (check all that you have): |
|
|
If you currently have insurance, please provide current insured limit |
|
|
| |
| |
|
|
|
|
| Do you smoke: |
|
| Do you have a monitored burglar alarm?: |
|
| Do you have a monitored fire alarm?: |
|
| Do you have sprinklers?: |
|
| Do you have a mortgage/secured line of credit on the property: |
|
|
|
|
|
| Was your prior policy canceled for non payment: |
|
| Have you ever been cancelled, declined, or refused personal insurance: |
|
|
|
| |
|
|
| Kilometers to the nearest Fire Hall: |
|
| Is Fire Hall: |
|
| Distance to the closest fire hydrant: |
|
| Solid Fuel Burning Stoves or Fireplace Inserts in the home: |
Do not count fireplaces except inserts |
| Solid Fuel Burning Units are for: |
|
| Oil tanks above or underground: |
|
| Dog owner: |
|
| Live in employees: |
Nannies, caretakers etc. |
| Short-term rentals of property to others: |
|
|
|
|
|
|
|
| Any roomers, boarders, or exchange students living in the home: |
|
|
|
|
Exclude basement & attached garage |
| Basement Type: |
|
|
|
|
|
|
|
|
|
|
|
| Building Construction Type: |
|
| Building Construction Quality: |
|
| Building Shape: |
|
| # of Full Bathrooms: |
|
| # of Half Bathrooms: |
|
| Garage Type: |
|
| Garage # of Cars: |
|
|
|
|
|
|
|
| Crawl Space: |
|
| Finished Attic: |
|
| Room over Garage: |
|
| Swimming Pool: |
|
| Hot Tub: |
|
|
Please describe, including sq ft area(s) |
| Has the home been completely gutted (new plumbing, wiring)?: |
|
| Home listed on any Historic Registry: |
|
| Wiring Main Panel Amperage: |
|
| Wiring Panel Type: |
|
| Wiring Updated: |
|
| Wiring Material: |
|
|
if applicable |
| Plumbing Types: |
|
| Plumbing Updated: |
|
|
if known |
|
Please advise of oldest installed hot water tank or year of on-demand system installation |
| Primary Heat: |
|
|
if applicable |
| Primary heating system serviced annually: |
|
| Primary Roof Material: |
|
|
|
| Reverse slope driveway: |
Does your driveway slope towards your house? |
| Cannabis grown at this location: |
|
| aBusiness activities conducted from the unit/dwelling: |
If you do not have another primary business location your business is considered to be operated from your home. |
| Scheduled Jewellery Coverage Required: |
Most policies include a limit of coverage for jewellery of $6000 or less subject to the policy deductible. Please advise if additional coverage is required. |
| Scheduled Bicycles Coverage Required: |
Most policies include a limit of coverage for bicycles of $1000 to $2500 per bike (or less) subject to the policy deductible. Please advise if additional coverage is required. |
|
Please use this area to tell us anything else you feel is important |
| front & back if available |
| |
| Required to prove you're not a bot! |
| |