COA Quote1

1

Please select the US state you are located in:

2

I'm sorry, but we currently are unable to provide insurance your state. We let applicants know this immediately, so that we don't waste your time. Please click the "X" in the upper right corner to exit this form.

3

When was construction of the oldest building(s) in your development completed?

Prior to 1970

After 1970

4

Have the buildings been completely renovated within the last 30 years

YESNO

5

I'm sorry, but currently our carriers are not currently accepting organizations that consist of building built prior to 1970 unless they have been completed renovated (electrical, plumbing, roofing, structural, etc). We let applicants know this immediately, so that we don't waste your time. Please click the "X" in the upper right corner to exit this form.

6

How many total buildings in your COA?

7

How many total units?

8

When did development start? (e.g. what is the age of the oldest building?)your best guess here is fine if you're not sure

9

What is the name of the condo association?* This field is required.

10

Please select the state {condoname} is in:* This field is required.

11

Zip code the condo association is located in?* This field is required.

12

And what is your name?

First Name

Last Name

13

Thanks {contactname:first}, and do you currently have COA insurance in place?

Yes

No

Not Sure

14

Ok, let's grab some info on your current coverage. This ensures we provide an accurate "apples to apples" insurance quote and don't waste your time. First, what is the name of your current COA insurance carrier?

15

Next, what is the annual premium of your current insurance? (ballpark estimate is fine)

16

Do you have your policy's declarations page handy? If so, please upload it. This will greatly speed up the quoting process for you.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

17

Have you had any losses/claims on your COA insurance within the last 3 years?

YESNO

18

Not a problem, {contactname:first}. Please provide a few details regarding the claims. What it was for, date, total cost.

19

Do you need Directors & Officers coverage?

Yes

No

I'm not sure

20

Almost done, {contactname:first}. Just need to grab your contact info for the quote. What phone number can we reach you at?* This field is required.please note: your contact info is kept private, not shared and is only used to discuss your quote with you.

Please enter a valid phone number.

21

And what email address can we send your quote to?* This field is required.please note: your contact info is kept private, not shared and is only used to discuss your quote with you.

example@example.com

22

What's got you shopping for insurance today?Select as many as you would like

Premium increase

Claims issues

Coverage concerns

Unsatisfied with current agent

Currently uninsured

Start-Up

Other