Canoe Associates Insurance Agency, Inc.

Apartment Bldg. Quote

Dwelling Fire/Apartment Building Insurance Quote

Property Information

Address of Property:
Property City:
Property State:
Property Zip:
New purchase Existing ownership
Number of units:
Building Square footage:
Year Built:
Occupancy:	Owner Tenant
Occupancy Type:
Plumbing type:	Copper Galvanized Mixed (Copper/Galvanized)
Foundation Type:	Slab Crawlspace over slab Pier & Post Other (list in remarks)
Type finished basement, if any:	None Full 25% 50% 75%
Type Roof:	Shingle Wood Shake Tar/Gravel Spanish Tile Metal Other
Type of Siding:	Brick Vinyl Wood Aluminum
Number of stories:	1 2 3 4 or more
# of feet to nearest fire hydrant:
# of miles to nearest fire station:
Currently Insured? Name of Carrier & how long insured?	Yes No
Coverage's
Building Coverage	$
Liability Coverage	$
Contents	$
Deductible $ ($250, $500, $1,000, etc.)	$
Other Coverage/Remarks: (describe any extra coverage's needed such as business interruption, robbery, computers, etc.):

Any claims reported on this property or previously owned properties in the last 3 years?	Yes No
Please describe: Include date(s) and details of claim:

Additional Comments

Please give any additional comments or questions

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