Proposal Request Company/Entity Name* Name* First Name Last Name Where is your business located?* United States Outside the United States Please input your business address, not to be confused with the address of your investment property(ies).Business Address International* Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Office Phone*Mobile PhoneEmail* Insurance Status* Currently insured - seeking alternatives New acquisition Policy canceled/not in force Current carrier non-renewing (enter reason in other below) How soon do you need coverage?* ASAP---Help! I close within the next 24 hours! Within the next week, or so Within the next 30 days No rush---next 30 days or more... When would you like your coverage to begin?*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Are you a full-time investor?* Yes No Working on it! What is the total number of properties in your portfolio?* Those you or your entity(ies) own, manage, or controlFor how many properties do you need a proposal today?* 1 2 3 4+ Property #1Property Address to be Insured Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Property Type*Single FamilyMultifamily (2-4 unit buildings)Apartment (5+Units)CondoVacant Land - Liability Coverage OnlyAssisted Living FacilityBar/TavernCommercialCommercial FarmingCondominium AssociationConvenience Store/Mini MartDormitories Fraternities or SororitiesGroup HousingIndustrial WarehouseLiquor StoreManufacturing OperationsMixed UseOpen Air MallReal Estate Development PropertyRehabilitation FacilityRestaurantRetailSelf-StorageStudent HousingBoarding HomesRooming HousesWill this location be used as a Vacation Rental?* Yes No Is this location leased to students?* Yes No Construction Type* Block Brick Frame Metal Modular/Mobile Year Built*Square Footage*If unknown enter closest approximationNumber of Stories*Is there a pool, spa, or hot tub at this location?* Yes No UPDATESPlease provide approximate year of last update. If unknown the year built will be used.Roof*Electric*Plumbing*HVAC*Are there any existing city/state housing code violations associated with this property?* Yes No Are there any local/state rental law, code or statute violations associated with this property?* Yes No Are locks changed or replaced upon a tenant leaving?* Yes No Are there any existing damage or maintenance issues at this property?* Yes No Does the location have a wood shake roof?* Yes No Are there piers and stilts? (excluding crawlspaces)* Yes No Is (either) Knob-and-Tube or Aluminum Wiring present?* Yes No Does the property have Exterior Insulating Finishing Systems (EFIS) on supporting structures?* Yes No Is this used for decorative purposes only and does it take up less than 10% of the structure?* Yes No Occupancy Status* Rental dwelling - Occupied (including condos) Renovation - Currently undergoing rehab (or within 30 days after acquisition) Vacant - Not undergoing renovation Force Placed - Vacant Force Placed - Occupied What is the total % of occupancy?*Is the porch or roofline sagging?* Yes No Are there any structural issues present?* Yes No Foundation, roof, or load bearing walls for example.Renters Insurance Requirement* Yes No For occupied locations, I require, enforce, and document, that tenants carry renters insurance.Other ConsiderationsDoes the property have any common areas?* Yes No Are functioning smoke detectors installed with replacement procedures in place?* Yes No Does any commercial cooking occur on the premises?* Yes No Does the attached parking available exceed 2,000 square feet or 24 spaces?* Yes No Are any of the following the primary heat source: wood-burning stove, kerosene, or portable space heater?* Yes No Does the property have an elevator, lift or hoist on premises?* Yes No Is Premises kept in a well-maintained status?* Yes No Would you like any of these additional coverages?Earth Movement - Protection for Sinkhole and Earthquake Shock perils. Coverage is not available in: AK, CA, FL, HI, or IL* Yes No Tenant Protector Plan - Investors alternative to renters insurance plus $1,000 Skip Rent coverage* Yes No Equipment Breakdown Coverage - for direct physical damage to the property caused by the breakdown of mechanical systems (HVAC, A/C, Water Heater, etc)* Yes No Equipment Breakdown Coverage - for direct physical damage to the property caused by the breakdown of mechanical systems (HVAC, A/C, Water Heater, etc)* Yes No Rental Assistance*What % of your tenants (if any) are subsidized?Is this location professionally managed?* Yes No Who monitors the property, how often?*Is there a Mortgagee or Third Party Lender?* Yes No Coverage Amount Requested (Please Enter "0" for Liability Only) $*Loss of Rents Amount Requested*Desired Deductible $2,500 $5,000 $10,000+ Need Help Deciding Are there any other structures on the property?* Yes No Do you wish to insure this structure from property damage?* Yes No Do you have more than one property to propose today?If yes then, then upload them as a spreadsheet here.FileMax. file size: 49 MB.Additional InformationHave you had any claims in the last 5 years?* Yes No Please describe any losses or damage not reported to an Insurance Carrier within the past 5 years.*Anything else you would like to tell us?A panda is black and _____* CAPTCHANameThis field is for validation purposes and should be left unchanged.
