Condo/ Co-Op Owners Quote
317 Pequot Avenue
PO Box 528
Southport CT 06890
203-255-2877 P
203-254-8427 F
CONTACT INFO:
NAME:
PHONE NUMBER: TYPE: ALT PHONE: TYPE: EMAIL:
PHONE NUMBER: TYPE: ALT PHONE: TYPE: EMAIL:You can quote, a home, condo, co-op, & renters policy here
NAMED INSUREDS:
NAME:DATE OF BIRTHOCCUPATION:EMPLOYER:RELATIONSHIPSELF CREDIT RATING
DATE OF BIRTHOCCUPATION:EMPLOYER:RELATIONSHIPSELF CREDIT RATINGINSURED LOCATION ADDRESS:
PRIOR ADDRESS ADDRESS:
IS THIS CONDO OWNED IN THE NAME OF AN LLC OR TRUST ?
IS THIS A NEW CONDO PURCHASE?
RESIDENCE TYPE?
YEARS AT THIS RESIDENCE
YEAR BUILT:
SQ FOOTAGE: BATHS STORIES DESCRIPTION BASEMENT GARAGE:
BATHS STORIES DESCRIPTION BASEMENT GARAGE:ALARM SYSTEM: SUMPS?
SUMPS? HEAT FUEL: ELECTRIC: CENTRAL AIR ROOF TYPE:: AGE OF ROOF
ELECTRIC: CENTRAL AIR ROOF TYPE:: AGE OF ROOF AGE OF FURNACE FLOOD ZONE? ESIMATED DISTANCE TO SHORE TRAMPOLINE? WOODSTOVE: SMOKER?
ESIMATED DISTANCE TO SHORE TRAMPOLINE? WOODSTOVE: SMOKER?PETS: HOW MANY: BREED:
ANY CLAIMS AGAINST THIS, OR ANY OTHER HOME OR RENTAL IN THE PAST 5 YEARS?
IS THERE ANYTHING TO BE SCHEDULED ON YOUR HOME POLICY? (SELECT A CATEGORY & LIST VALUE)
IN JUlY OF 2010, CT CHANGED THE LAWS FOR CONDO ASSOCIATIONS THAT REQUIRED THE ASSOCIATION TO DO ONE OF THE FOLLOWING. PLEASE SELECT:
UNIT ADDITIONS & ALTERATIONS if Other
PERSONAL PROPERTY/ CONTENTS If Other:
CONTENTS PERILS:
LOSS OF USE
COMPREHENSIVE LIABILITY
MEDICAL PAYMENTS
ALL PERIL DEDUCTIBLE
COVERAGE:
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