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Homeowners Association Insurance
   
Planned Unit Development Quotes
   Including New condo Conversions  
 

Personal Information
     

 First Name   Last Name
 Address   Suite / Apt
 City   Zip Code
 Home Phone   Work Phone
 Best time to call AM/PM   E-mail

Property Information
Address to be insured
      

 Property
 Address		      Zip Code  
 City of
 Association		      County*  
 
 Stories 1,2,3  #of Stories        Year Built 19xx - 20xx     
 Family 
 Units		 1,2,3,4 #of Units       Total Units Total Units in Complex
 Total
 Buildings		 Total # of Buildings     Living Area Sq Feet  (Each Unit)   
   
 D&O 
 Coverage		  $ Amount       Garages # of Garages / Carports  
 Liability   $ Amount       Pool Yes / No                
 Director's
 Officers		   $ Amount       Roof Type  
      
                              

                   Current Insurance Information          

 
     

  Current
  Insurance
  Company

  Claims in the

  Last 5 Years

 Yes    
No
 
      Please explain
  Any Claims
 Policy Expires              
  Deductible

Yearly Premium  

   

As part of the Insurance process.
You will need a 5 Year Loss run from your current insurance company

                              

 Type of  Property 

   Condo Association

       
        Current Building Value

  
  PUD  Association*
                 *PUD does not cover the Buildings - Common Area Liability  only
 
 Other 
 Information 
 to Include		   How were
  you referred
  / Web Site		  
 

Please write the "Name Of The Condo Association" in the box     

 
    By clicking the Submit button I have Reviewed the Privacy Statement and Understand that this
    is only quote information and does not constitute a binder of coverage or proof of Insurance in any form,
    or does it guarantee insurance. All Coverage's are subject to the terms and conditions contained
    in the policy and endorsements.  I agree the above information is  true and factual. Insurance  will not begin until 
    I sign and make a down payment on the insurance Application.   

                                                            This is not a binder or proof of Insurance.		  


                                                                                                           

                                                                         Please Read Auto Insurance Disclosure Statement below
                           By clicking the submit button I agree with the statements and privacy statement and agree to with all terms and conditions.    
     As part of the application process, Our Insurance Co. may collect personal information from
     Persons other than you or other individuals proposed for coverage, including credit reports for
     certain types of policies, loss information reports and other reports.  We will also inspect your home
     for brush and condition. This information, as well as other personal or privileged information
     subsequently collected by us, may in certain circumstances be disclosed to third parties without your
     authorization. This is a condensed version of the Home Disclosure statement.. 
   
     You have a right of access a full version and correction with respect to personal information we collect.
     If you would like more detailed information in writing about our information collection practices, 
     please let us know    
    

    Contact Information    

 

   Toll Free  (877) 660-8585    
    Office (619) 562-8585    
    Fax (619) 564-3400    
    After Hours (619) 670-1200      
   

Email Ronn Hall