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Fields marked (*) are mandatory.
What Names are on the Property Appraiser?*
Policy Effective Date:*
Company*
Price:*
H03
DP3
H06/H04/ Vacant
Owner Occupied*
Tenant Occupied*
Is there a fire hydrant within 1000 feet of home/ property?*
Is there a fire station within 5miles of the home?*
Is this home under any type of trust or a LLC?(Most companies only allow living trust and can't quote liability or med pay)
If yes how is it listed?
Have you ever had any repossessions or bankruptcy in the last 5 years?*
If yes Explain:
Have you ever been convicted of any crime or felony?*
If yes Explain:
Have you had any previous claims in the last three years such as water or named perils? *
If yes Explain:
Do you have any Day Care Activities on the premises?*
If yes Explain:
Is there any farming or any other types business conducted on the property?*
If yes Explain:
Is this property on 5acres or more?
Is this home for sale or being rented?
If yes Explain:
Is the risk 40 feet or less from a commercial property?
If yes Explain:
Is this property condemned due to condition or located in a condemned area?*
If yes Explain:
Does this property have existing damage/disrepair?*
If yes Explain:
Is this a gated community or is there a security guard on the premises?
Is there any piles of debris outside or anything that could cause a liability hazard such as appliances?*
If yes Explain:
Is the dwelling or other structures rebuilt or constructed with extensive remodeling on a do-it-yourself basis?
If yes Explain:
Was this property ever constructed for anything other than a personal home?
If yes Explain:
Does this property have any external heating or cooling such as window units be used?
If yes Explain:
Does this property have a fraternity,or any similar housing arrangement?
If yes Explain:
Structure constructed “near”, partially. or entirely on water?*
If yes Explain:
Is dwelling built on a landfill previously used for refuse?
If yes Explain:
Does this property have a skateboard or bicycle ramp?
If yes Explain:
Is there any recreational vehicles on the property? (go carts, 4wheeters, etc)
Is there a Trampoline on the premises?
Does this property have a pool?*
Is there a slide or divingboard?*
If so is there a fence or screened enclosure around the pool?
If yes Explain:
Is there any animals on the premises are in the home?*
If yes Explain:
Does this property have any current or prior sinkhole loss? Has sinkhole activity such as cracks in the wall or in the foundation occurred. Has there ever been a sinkhole inpection on this home.*
If yes Explain:
Is this property under construction?
If yes Explain:
Is there any scheduled items such as jewelry, fur, or etc that needs to be on this policy?s
If yes Explain:
Do you have an monitored fire & burglar alarm on this house?
If yes need alarm certificate to receive credit
What is the shape of your roof? If policy is being written with Sunshine State or Citizens pics are required.
Was your roof built 2002 or later or is your roof built up to the 2002 building codes? If yes please get a wind mitigation form filled out by an inspector and receive credits on your policy.