Multifamily Property Quote Request Insured's Name/LLC Owner's Name * First Name Last Name Mailing Address Address 1 Address 2 City State/Province Zip/Postal Code Country Insured's Email Address Coverage Effective Date MM DD YYYY Coverage Type Rental Rehab Property Coverage Amount $ Loss of Rent Coverage Annual Business Income Contents Coverage Amount (Optional) $ Address of Property Address 1 Address 2 City State/Province Zip/Postal Code Country Square Footage of Property Number of Units Number of Stories Is There a Basement? Yes No Year of Last Roof Replacement Was the Roof Replacement Partial or Complete? Partial Complete Year of Last Plumping Replacement Was the Plumping Replacement Partial or Complete? Partial Complete Year of Last Electric Replacement Was the Electric Replacement Partial or Complete? Partial Complete Year of Last Heating Replacement Was the Heating Replacement Partial or Complete? Partial Complete Please List Any Losses For Last 5 Years Lender Name (If Applicable) Lender Mailing Address Address 1 Address 2 City State/Province Zip/Postal Code Country Loan Number Thank you!
