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Quote Page 9

Property Details

Year home/residence was built: *

Purchase Date (mm/dd/yyyy): *

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How much would it cost to replace your home/residence (minus land value)? *

,This is the cost of rebuilding your home at today\'s prices. It is not the selling price, nor the market value. It also does not include the cost of the land or any other structures on your property.

How much Personal Property coverage do you want? *

Square footage (excluding basement): *

Number of Stories: *

Protection Information

Distance to fire department (miles): *

Is the property located within city limits? *

Yes No

Distance to fire hydrant (feet): *

,How far is 1,000 feet? - A distance of 1,000 feet is roughly equivalent to 300 meters, or around 3 football fields. At a normal walking pace (3 mph), it would take around 3.5-4 minutes to walk 1,000 feet.

Within Fire District: *

Yes No

Distance to tidal water or coast (miles): *

,How do I determine distance to tidal water? - When determining distance to tidal water or coast, make sure that you are take into consideration how far your property is from the coast in air miles. You may also think of this distance in terms of miles \'as the crow flies\'. Driving distance to the tidal water or coast is not important here.

Protection Class *

Structure Information

Is this home your primary or secondary residence? *

How many families reside in the home? *

No Of Apartments

Structure *

What is the construction type of the home/dwelling (60% or more)? *

What type of roof does the home/dwelling have? *

Roof UL Classification

Roofing Update *

Roofing Update Year *

What is the primary source of heat? *

Do you have an alternate source of heat other than a fireplace (e.g. wood burning stove)? *

Yes No

Secondary Heating Source Type

Heating Update *

Year Heating Renovated/Replaced *

Does this home have an electric circuit breaker? *

Yes No

Electrical Update *

Year Electrical Updated *

Plumbing Update *

Year Plumbing Updated *

Do you own any dogs of these breeds (Rottweiler, German Shepard, Doberman, Pitbull, Chow, Wolf Hybrid or mix of these)? *

Yes No

Do you conduct any type of business on this property (e.g. daycare, beauty salon)? *

Yes No

Business Name

Is Business Incidental?

Yes No

Business Class

How many full-time domestic employees do you have? *

Wood Burning Stove *

Yes No

Number Of Wood Burning Stoves

First Mortgagee:

Yes No

Second Mortgagee:

Yes No

Third Mortgagee: *

Yes No

Co-Signer: *

Yes No

Equity Line Of Credit: *

Yes No

Number Of Other Interests *

Property Accessories

Swimming Pool *

Yes No

Swimming Pool Fenced *

Yes No

Swimming Pool Type *

Trampoline *

Yes No

Smoke Detectors *

Yes No

Fire Extinguisher *

Yes No

Indoor Fire Sprinkler *

Yes No

Burglar Alarm *

Yes No

Deadbolt *

Yes No

Gated Community *

Yes No

Retirement Community *

Yes No

Building Additions or Alterations *

Yes No

Building Additions or Alterations Amount

* required field

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