Birthday: *

This is for the purpose of any age related discounts.

MM

DD

YYYY

Phone Number: *

(###)

###

####

Is it just yourself in the unit? *

You may answer no if anyone is under 21 and in your care.

Yes

No

Birthday of 2nd occupant (if applicable):

You may leave anyone who is under 21 and in your care.

MM

DD

YYYY

Is there anyone else not listed above that occupy your unit with you?

You may leave out anyone who is under 21 and in your care.

Yes (we will reach out for details after)

No

Date coverage needs to be bound:

Leave blank if coverage not needed on a certain day.

MM

DD

YYYY

Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is your unit located at the ground level, partially, or fully below ground level? *

No, unit is above first floor

Fully below ground

Partially below ground

Ground level

Is there any commercial businesses in the building? *

My building is all residential.

There is some commercial occupancy in the building.

What is the primary heating source for the unit?

Primary means permanently installed heating throughout the unit, centrally controlled by a thermostat.

Electric baseboard

Hot water baseboard or radiator

Forced air furnace

In floor hot water

In floor electric

In ceiling radiant hot water

In ceiling radiant electric

Heat pump

Geothermal

Oil furnace

Wood burning appliance

Does the hot water come from a central boiler, or a hot water tank in the unit? *

Central boiler

Hot water tank in the unit

Tankless "on demand" hot water in the unit

What is the construction of the building? *

Most low rise (under 5 floors) apartment buildings are frame construction. Buildings over 5 floors are almost always concrete. If you are unsure, please phone your landlord.

Frame (wood)

Concrete (fire resistive)

Concrete (fire resistive) bottom floor, Frame (wood) above

Has any Insurance Company refused to renew, cancelled, or declined to provide insurance in the past 6 years? *

No

Yes

How did you hear about us? *

Ive been a client before.

I found you on Google.

I found you on another search engine.

I was given a business card.

I was mailed a flyer.

I've seen your business on West Broadway.

On title, is the ownership in the name of a company? *

No

Yes (we will reach out for details after)

Birthday: *

This is for the purpose of any age related discounts.

MM

DD

YYYY

Phone: *

(###)

###

####

Is it just yourself in the unit? *

You may answer no if anyone is under 21 and in your care.

Yes

No

2nd Person on Title Birthday (if applicable):

MM

DD

YYYY

Is there anyone else not listed above that occupy your unit with you?

You may leave out anyone who is under 21 and in your care.

Yes (we will reach out for details after)

No

Date coverage needs to be bound:

Leave blank if coverage not needed on a certain day.

MM

DD

YYYY

Date you will be moving/sleeping there:

While the property is vacant there will be restrictions in coverage in place and depending on the length of vacancy additional premium charged.

MM

DD

YYYY

Is this unit part of a co-op? *

No

Yes

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is your unit located at the ground level, partially, or fully below ground level? *

No, unit is above first floor

Fully below ground

Partially below ground

Ground level

Is there any commercial businesses in the building? *

My building is all residential.

There is some commercial occupancy in the building.

Is there any Polybutylene (Poly-B) plumbing in the building supply lines? *

If you are unsure, consult with the strata council, property management, or your realtor for the answer.

No

Yes

Plumbing material in the unit: *

Select all that apply

Copper

Polybutylene (Poly-B)

PEX manufactured by Kitec, Zurn, Vanguard, or Uponor

PEX manufactured by other companies

PEX unknown manufacturer

Unknown

Is there a hot water tank in the unit, or is it provided by a central boiler? *

Central boiler

Hot water tank in unit

Unknown

What is the primary heating source for the unit? *

Primary means permanently installed heating throughout the unit, centrally controlled by a thermostat.

Electric baseboard

Hot water baseboard or radiator

Forced air furnace

In floor hot water

In floor electric

In ceiling radiant hot water

In ceiling radiant electric

Heat pump

Geothermal

Oil furnace

Wood burning appliance

What is the construction of the building? *

If you are unsure, please contact your strata council.

Frame (wood)

Concrete (fire resistive)

Concrete (fire resistive) bottom floor, Frame (wood) above

Has any Insurance Company refused to renew, cancelled, or declined to provide insurance in the past 6 years? *

No

Yes

How did you hear about us? *

Ive been a client before.

I found you on Google.

I found you on another search engine.

I was given a business card.

I was mailed a flyer.

I've seen your business on West Broadway.

On title, is the ownership in the name of a company? *

No

Yes (we will reach out for details after)

Birthday: *

This is for the purpose of any age related discounts.

MM

DD

YYYY

Phone: *

(###)

###

####

2nd Person on Title Birthday (if applicable):

This is for the purpose of any age related discounts.

MM

DD

YYYY

Is the unit currently occupied by a tenant? *

Yes

No

With the current tenants, did the lease start on a 6 month or 1 year term? *

Yes, the initial term was on a 6 month or 1 year term

No

This unit is unoccupied

How many tenants occupy this unit? *

IMPORTANT: For the purposes of this question tenants are unrelated individuals. A couple or a family would be a single tenant. Two unrelated roommates or two couples would be two tenants.

1

2

3 or more

This unit is unoccupied

Do the tenants run a home based business or have a hobby that provides an income from the premises? *

A tenant who is an employee working from home can be answered with a No. If the tenant has clients on premises or does any sort of manufacturing, repairing, or anything other than phone and computer work, please answer with a Yes.

No

Yes

This unit is unoccupied

Do you have a property manager who selects tenants, collects rent, or arranges maintenance? *

No

Yes

Your Home Address *

The address where the owners reside. If there are multiple owners at multiple addresses please enter the address that is closest to the rented condo.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

The Rented Condo Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is your unit located at the ground level, partially, or fully below ground level? *

No, unit is above first floor

Fully below ground

Partially below ground

Ground level

Plumbing material in the unit: *

Select all that apply

Copper

Polybutylene (Poly-B)

PEX manufactured by Kitec, Zurn, Vanguard, or Uponor

PEX manufactured by other companies

PEX unknown manufacturer

Unknown

Is there any Polybutylene (Poly-B) plumbing in the building supply lines? *

If you are unsure, consult with the strata council, property management, or your realtor for the answer.

No

Yes

Is there a hot water tank in the unit, or is it provided by a central boiler? *

Central boiler

Hot water tank in unit

Tankless on demand hot water

Unknown

What is the primary heating source for the unit? *

Primary means permanently installed heating throughout the unit, centrally controlled by a thermostat. Electric baseboard

Electric baseboard

Hot water baseboard or radiator

Forced air furnace

In floor hot water

In floor electric

In ceiling radiant hot water

In ceiling radiant electric

Heat pump

Geothermal

Oil furnace

Wood burning appliance

What is the construction of the building? *

If you are unsure, please contact your strata council.

Frame (wood)

Concrete (fire resistive)

Concrete (fire resistive) ground floor, frame (wood) above

Has any Insurance Company refused to renew, cancelled, or declined to provide insurance in the past 6 years? *

No

Yes

How did you hear about us? *

Ive been a client before.

I found you on Google.

I found you on another search engine.

I was given a business card.

I was mailed a flyer.

I've seen your business on West Broadway.

On title, is the ownership in the name of a company? *

No

Yes (we will reach out for details after)

Birthday: *

This is for the purpose of any age related discounts.

MM

DD

YYYY

Phone: *

(###)

###

####

2nd Person on Title Birthday (if applicable):

MM

DD

YYYY

Other than the names above, is there anyone else on title? *

No

Yes

If this home is owner occupied, is there anyone who lives with you that is not listed above?

You may leave off anyone who is under 21 and in your care.

No

Yes

What type of wiring is used?

Copper

Aluminum

Mixed copper/aluminum

Is the electrical on breakers or fuses?

Breakers

Fuses

Plumbing Material:

Select all that apply

Copper

Polybutylene (Poly-B)

PEX manufactured by Kitec, Zurn, Vanguard, or Uponor

PEX manufactured by other companies

PEX unknown manufacturer

Unknown

Cannabis Plants: *

How many Cannabis Plants grown in your unit?

None

Always 4 or less

May have 5 or more

Has any Insurance Company refused to renew, cancelled, or declined to provide insurance in the past 6 years? *

No

Yes

How did you hear about us? *

I've been a client before.

I found you on Google.

I found you on another search engine.

I was given a business card.

I was mailed a flyer.

I've seen your business on West Broadway.

Name *

First Name

Last Name

Name *

First Name

Last Name

Name *

First Name

Last Name