Basic Property Insurance Quote Request
When do you want this policy to start?
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Immediately or specific date
What name/names/entity should be listed on this policy? In other words, who owns this property today?
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John & Jane Doe -or- Estate of John Doe -or- John Doe Properties LLC
If individual(s), please list names & date(s) of birth
Name(s), Phone numbers, email addresses for all policy contacts
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Policy Mailing Address
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Property questions
What is the intended plan for the property long term?
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Vacant & for sale; Renovation and move in as primary residence; Renovate and sell; etc
Property Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is there currently insurance on this property?
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Please Select
Yes
No, it lapsed more than 30 days ago
No, but it lapsed within the last 30 days
Unknown
What best describes the current policy needed
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Please Select
Owner Occupied Primary Residence
Owner Occupied Secondary Residence
Tenant Occupied Primary Residence w/Annual Lease
Tenant Occupied Primary without annual lease
Tenant Occupied, Short term 3 day rental minimum.
Something else.
What is this property's main construction type
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Please Select
Frame on 3 or more sides (hardiboard, wood siding, vinyl siding, etc)
50% frame & 50% something else
Brick on 3 or more sides
Block on 3 or more sides
Stucco on 3 or more sides
Do you have a property management company for this property?
Please Select
Yes
No
How far away from this property is your primary residence?
Please Select
less than 100 miles
more than 100 miles
What year was this property built?
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Square Footage
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Heated and cooled, Approximate is ok.
How close is the nearest fire hydrant?
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Please Select
Within 1000 feet of the property
More than 1000 feet from the property
Property Type
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Please Select
Single Family (detached from any others)
Single Family unit - attached to other units not owned by me (this entity)
Duplex (own both units)
Triplex, Quadraplex or bigger & own all units
Mobile Home
Condo Unit
How many units are we covering
Please Select
1
2
3
4+
Number of floors
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Please Select
1
2
3+
I'm not sure
Roof Material
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Please Select
3-Tab Basic Single
Architectural Single
3-tab or Architectural, i'm not sure which.
Tile/Metal/Stone/Concrete
Something else
Make your best guess if you are not sure
What year was the roof completely replaced?
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How much would it take to rebuild this property if it were totally destroyed?
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In other words, how much coverage do you want on this structure? We can adjust this before finalizing - this just gives us a starting point.
How high of a deductible can you handle if it saves a significant amount of premium?
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Please Select
$1000
$2500
$5000
$10,000
$15,000+
The higher a deductible you can take, the lower the premium can be. We can give you options, this helps give us an idea of what would be too much.
How much coverage for contents within the structure do you want?
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Please Select
$0 - None
$5,000
$10,000
$25,000+
Contents would be non-permanently attached property such as furniture, clothes, etc.
How much coverage do you need for Screen Enclosures/Screen Porches?
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Please Select
$0 - None
$10,000
$15,000
$20,000
$25,000
$30,000+
We can clarify or adjust before finalizing.
Is there a mortgage on this property?
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Please Select
Yes
No
Mortgage Company Name
Mortgage Company Address
Mortgage Loan Number
Is there any existing damage on this structure?
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Please Select
No
Yes - there is existing damage
Number of claims or losses, within the last 5 years, on this property or ANY OTHER PROPERTY owned by the people/entity to be insured?
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Please Select
0 - None
1
2
3+
Please describe claims including date of loss, where it happened, how much was paid, and a brief summary of what happened.
I understand the loss settlement provision for this policy is ‘actual cash value’ for damage done. This means payment will be reduced/depreciated.
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Please Select
Yes - I understand coverage is not replacement cost
No (not eligible for coverage)
I understand this policy only covers the following perils: Fire; Lightning; Internal Explosion (not including bursting caused by water, i.e. pipe bursting); Windstorm or Hail; Smoke; Aircraft or Vehicles; Riot or Civil Commotion; Vandalism – glass excluded Volcanic Eruption
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Please Select
Yes - I understand no other perils are covered
No (not eligible for coverage)
No coverage for water, falling objects, mold, accidental discharge of water/steam, etc
I understand no coverage is bound until confirmed with a licensed agent of McGinniss Himmel Insurance Agency, LLC. I also understand that this paperwork does not alter the actual contract(s) of insurance. For coverage details I will need to refer to the policy(ies) for the actual contract and coverage language. In the event of conflicting statements, the policy conditions supersede this document.
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Please Select
Yes - I understand no coverage is bound & this document cannot alter the actual contract of insurance.
No (not eligible for coverage)
How would you like to make your first payment?
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Please Select
Credit Card (generally no fee)
EFT from checking account (no fee)
We can change this before finalizing
If paying other than in full annually, would you prefer to pay by recurring credit card or recurring EFT from a checking account?
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Please Select
Credit Card Recurring
EFT Recurring
Pay in full annually (bill by mail)
The only bill by mail option is to pay in full annually
Please verify that you are human
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Submit
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