Employment Opportunities with Haines & Haines/T.C. Irons

Building Insurance Quote

CORPORATE INFORMATION
Legal Entity That Owns Building
Mailing Address of Corp
City
State	-- NJ PA NY DE
Zip Code
Web Site (if available)
Number of Buildings

 

LOCATION/S - (If more than five (5) locations contact us directly)
LOCATION ADDRESS / DEVELOPMENT NAME	SQ. FT.	# UNITS	STORIES

 

LIST RETAIL/COMMERCIAL TENANTS (if any)

Include Sq Ft and Type of Business . . . 1. ABC Company, 2,500 Sq Ft, Clothing

 

GENERAL PROPERTY INFORMATION
Year of Construction
Construction Type	***SELECT*** Frame Masonry Veneer Masonry Superior Other (Complete Below)
Other Construction Type
Roof Type	***SELECT*** Composite Material Metal Tile Slate Woodshake Other (Complete Below)
Other Roof Type
Foundation Type	***SELECT*** Crawl Space Piers / Pilings / Stilts Slab on Grade Unfinished Basement Walkout Basement Wood Foundation Basement Other (Complete Below)
Other Foundation Type
Is There Central Heating & Air Conditioning?	YES      NO
Stairwells Inside or Outside Building	INSIDE OUTSIDE
If Inside	OPEN   CLOSED
If Basement Exists - Square Footage
Is Bsmnt Occupied?	YES      NO
If Bsmnt Occup - 2 Means of Egress?	YES      NO
# of Elevators	NONE
# of Vacant Units
Garage Type	***SELECT*** Outdoor - Assigned Outdoor - Not Assigned Indoor Garage
Sq. Ft. Parking Area / Garage
Are There Circuit Breakers?	YES      NO
Copper Wires?	YES      NO
Heating System Type	***SELECT*** None Heat Pump Electric Gas Oil
If Oil, Tanks Above or Below Ground	ABOVE      BELOW
Cooling System Type	***SELECT*** None Central Air Evaporative Cooler Window Units
Is the Plumbing Copper?	YES      NO
BUILDING UPDATES ROOF (Updated) ELECTRIC (Updated) HEATING (Updated) PLUMBING (Updated) Yes No Yes No Yes No Yes No (If yes, year) (If yes, year) (If yes, year) (If yes, year)

 

BASIC FIRE SAFETY PROTECTION INFORMATION
Distance from Fire Protection (Hydrant)	***SELECT*** Less Than 1000 Ft. Over 1000 Ft.
Distance from Fire Station	***SELECT*** Less Than 5 Miles More Than 5 Miles More Than 10 Miles
Is Your Area A "Brush" Area?	YES NO
Is There a Standpipe?	YES NO
Is There Emergency Lighting?	YES NO
Are Exit Signs Illuminated?	YES NO
Are There Smoke Detectors At This Location?	YES NO
Smoke Alarm At Location?	YES No
Are There Fire Extinguishers?	YES NO
Are There Interior Automatic Fire Sprinklers?	PARTIAL FULL NONE
Fire Alarm	***SELECT*** Local Central Station None
Theft Alarm	***SELECT*** Local Central Station None
What Is The Fire District?

 

POOL INFORMATION
Is There a Pool?	YES NO
Is Pool Fenced?	YES NO
Is There A Diving Board?	YES NO
Is There A Slide?	YES NO
Life Guard On Duty?	YES NO

 

COVERAGE REQUEST
Building Amount
Loss of Rent
DEDUCTIBLE	***SELECT*** $500 $1,000 $2,500 $5,000 $10,000 $15,000 $20,000 $25,000 $50,000
General Liability	***SELECT*** $1,000,000 $2,000,000
Losses-Are There Claims in the Last 5 Years?	YES No
If Losses and/or Claims List - Date, Amount Paid and Description of Each Loss

 

ADDITIONAL COVERAGE REQUEST
Umbrella	Boiler & Machinery
Workers Compensation	Directors & Officers
Business Auto	Flood

 

CURRENT COVERAGE INFORMATION
Current Insurance Carrier
Current Expiration Date
Current Premium

CONTACT INFORMATION
First Name Last Name Email Phone                        Fax    Questions / Comments / Notes
Send my quotation via	E-Mail Fax Regular Mail Call me by Phone!
All quotes are based on the information that the applicant  provides, and are subject to change based on final underwriting by the  individual carriers.

 

 

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Privacy Policy-We routinely collect personal and/or business information that is needed as part of the quoting and underwriting process.  We also collect the same information as part of service and update activities.  The Haines & Haines/T.C. Irons Agency will not share that information, or use it in any other way, with outside parties, vendors, etc.

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