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

Commercial Flood Insurance Quotation

GENERAL INFORMATION

Name of Insured / Corporation / Property DBA (if applicable) Mailing Address City State      Zip: -- NJ PA NY DE   Company Web site Address Any Claims / Losses? YES No Reason for Request ***SELECT*** Voluntary Request Bank Required Loan Closing Is Location Insured's Principal Address? ***SELECT*** Yes No

 

PHYSICAL LOCATIONS (if more than 5 include in Notes Section on Bottom of Page)
Address	Mkt. Value	Bldg Amt.	Contents Amt.
LOC 1.
LOC 2.
LOC 3.
LOC 4.
LOC 5.

 

LOCATION INFO
Construction Date
Property Type	***SELECT*** Primary Residence Secondary Residence Property Rented to Others Condo/Coop
Occupancy Type	***SELECT*** Single Family Two Family Three Family Split Level Mobile Home Other (Complete Below)
Other Occupancy Type
Number of Units
Construction Type	***SELECT*** Frame Joisted Masonry Other
Basement Type	***SELECT*** Finished Unfinished Below Grade Crawl Space No Basement Other
If Basement     - Does it hold Equipment (describe)
Number of Stories
More Than 1 Building	YES No
# of Buildings
If More Than 1 Building - Distance Between?	***SELECT*** 25-100 Feet Over 100 Feet Less Than 25 Feet Other
Elevated Building	YES No
Is Garage Attached to Building	YES No
If Attached      - List Equipment or Machinery Stored

COVERAGE INFO
Contents Coverage
Contents Coverage Deductible	***SELECT*** $500 $1,000 $2,000 $3,000 $4,000 $5,000 $10,000 $15,000 $20,000 $25,000
Building Coverage
Building Coverage Deductible	***SELECT*** $500 $1,000 $2,000 $3,000 $4,000 $5,000 $10,000 $15,000 $20,000 $25,000
Estimated Replacement Cost

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.

Policy Coverage and Disclaimer