DP1 Questionnaire for quote

When do you want this policy to start?*

Immediately or specific date

What name/names/entity should be listed on this policy? In other words, who owns this property today?*

John & Jane Doe -or- Estate of John Doe -or- John Doe Properties LLC

If individual(s), please list names & date(s) of birth

Name(s), Phone numbers, email addresses for all policy contacts*

Policy Mailing Address*

What is the intended plan for the property long term?*

Vacant & for sale; Renovation and move in as primary residence; Renovate and sell; etc

Property Address*

Street Address

Street Address Line 2

Postal / Zip Code

Is there currently insurance on this property? *

What best describes the current policy needed*

What is this property's main construction type*

Do you have a property management company for this property?

How far away from this property is your primary residence?

What year was this property built?*

Square Footage *

Heated and cooled, Approximate is ok.

How close is the nearest fire hydrant?*

Property Type*

How many units are we covering

Number of floors *

Roof Material *

Make your best guess if you are not sure

What year was the roof completely replaced?*

How much would it take to rebuild this property if it were totally destroyed?*

In other words, how much coverage do you want on this structure? We can adjust this before finalizing - this just gives us a starting point.

How high of a deductible can you handle if it saves a significant amount of premium?*

The higher a deductible you can take, the lower the premium can be. We can give you options, this helps give us an idea of what would be too much.

How much coverage for contents within the structure do you want? *

Contents would be non-permanently attached property such as furniture, clothes, etc.

How much coverage do you need for Screen Enclosures/Screen Porches?*

We can clarify or adjust before finalizing.

Is there a mortgage on this property?*

Mortgage Company Name

Mortgage Company Address

Mortgage Loan Number

Is there any existing damage on this structure?*

Number of claims or losses, within the last 5 years, on this property or ANY OTHER PROPERTY owned by the people/entity to be insured?*

Please describe claims including date of loss, where it happened, how much was paid, and a brief summary of what happened.

I understand the loss settlement provision for this policy is ‘actual cash value’ for damage done. This means payment will be reduced/depreciated.*

I understand this policy only covers the following perils: Fire; Lightning; Internal Explosion (not including bursting caused by water, i.e. pipe bursting); Windstorm or Hail; Smoke; Aircraft or Vehicles; Riot or Civil Commotion; Vandalism – glass excluded Volcanic Eruption*

No coverage for water, falling objects, mold, accidental discharge of water/steam, etc

I understand no coverage is bound until confirmed with a licensed agent of McGinniss Himmel Insurance Agency, LLC. I also understand that this paperwork does not alter the actual contract(s) of insurance. For coverage details I will need to refer to the policy(ies) for the actual contract and coverage language. In the event of conflicting statements, the policy conditions supersede this document.*

How would you like to make your first payment? *

We can change this before finalizing

If paying other than in full annually, would you prefer to pay by recurring credit card or recurring EFT from a checking account? *

The only bill by mail option is to pay in full annually

Please verify that you are human*

Basic Property Insurance Quote Request

Property questions