Muller Insurance - Complete Insurance Packages for Individuals and Businesses

Condo Association Quote

Contact Information
Date:		Need By (Date):
Expiration date:
Contact Name:		Contact Email:
For inspection:
Mobile #:		Work #:
Home #:		Fax #:
Condo Information
Condo Assn. Name (As on deed):		Condo Address:
Condo City:		Condo State:
Condo County:
Mailing Address:		How many units in building?
How many owner occupied units?		Maintenance Fees:
Business on premises?	Yes No	Business Type:
Do you need directors/officers liability?	Yes No	Business distance in ft.:
Construction:		How many years a condo?
Measurements of house only:	Width:	Length:	Floors: Sq. ft.:
Exposure left:	Ft.	Exposure right:	Ft.
Year Built:		Condition:
Heating System:
Does Building have Sprinklers?	Yes No	Totally sprinklered?	Yes No
Sidewalk Condition:		Any cracks, holes, raised?
Updates? When (date):	Roof : Plumbing: Heating: Electric Amperage:
Does Building have any alarms?	Smoke: Central Burglary: Central Fire: Local Gong: Roll Gates: Annunziators: Stand Pipes:
Insurance Coverage Information
How much fire insurance needed on condo building?		Fire insurance needed - Other:
How much liability in public areas needed?		Umbrella amount in Millions:
Need Boiler & Machinery Insurance?	Yes No	Assn Need Flood insurance?	Yes No
Need fidelity bond?	Yes No	Medical Payments?
Building have superintendent?	Yes No	Need Workers Compensation?	Yes No
Annual Payroll of superintendent:		Payment Plan:	Yes No
Additional Information
What company insures you now?		Current premium:
Why do you want to switch?	Pricing: Switch Agent: Being Cancelled: Cancelled:
Been cancelled in last 3 years?	Yes No	If yes, why?
Losses in the past 5 years?	Yes No	If yes, type of Loss:
If yes, date of Loss:		If yes, amount of Loss:
Do you need your condo interior quoted?	Yes No	If yes, amount needed:
Referred by:		Other:
Notes:


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