Property Quote Form

Property Insurance Quote Form

Property Quote Form

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GENERAL INFORMATION

Business Legal Name:		Phone:
Mailing Address:		Contact:
City:	State: Zip:	Email:

POLICY INFORMATION

Check if No Current Insurance Coverage, or Complete Below:

Current Carrier: Expiration Date: Current Premium:
(Not Agency) State "NONE" if no current coverage.

INFORMATION & LIMITS OF INSURANCE
NOTE: Building Owners & Tenants must complete the below information if any Property is to be covered.

LOCATION #1

Physical Address, City, State, Zip:

Occupancy (Ex: Office, Store, Shop, Storage): Other Tenants Occupancies:

Surrounding Area Best Described as: City....Town....Rural --&-- Residential....Commercial....Open

Construction

: # Stories: Square Feet Occupied by You: Total Sq. Feet Bldg:

Year Built: Is Bldg Stand Alone or Connected to Bldg's: Stand Alone..Connected # of Apartments?

Updates to Bldg

: Electrical: Plumbing: Heating/AC: Roof: or All Within 10 Years?Y..N

Is Property Located in a Flood Zone?Y..N # of Feet from River?

PROPERTY PROTECTION

Is there a Central Station (24/7 Monitored)

Burglar Alarm?Y..N Fire Alarm?Y..N

# of Miles to Fire Department? # Feet to Fire Hydrant?or None (check) Is Building Sprinklered?Y If Yes, What %?

LIMITS OF INSURANCE

Building Limit

: Replacement Cost

or check if you wantActual Cash Value

Contents Limt

: Replacement Cost

or check if you wantActual Cash Value

Choose your Property Deductible

: This Deductible will apply to all Locations & Buildings

EQUIPMENT FLOATER

For equipment that leaves any scheduled premises.
Miscellaneous Tools & Equipment, Total Value

: Blue Book Value

: Replacement Cost Value:
Scheduled Equipment, Total Value

: Blue Book Value

: Replacement Cost Value:
The equipment limits listed under this floater are: Included in the above Contents Limit In Addition to the above contents Limit N/A No Contents Limits Listed
Choose your Tools / Equipment Deductible

: This Deductible will only apply to this coverage.
Address of where equipment is stored overnight most of the time?
Briefly describe WHERE the equipment is stored overnight (ie shed, warehouse, etc) and type of security (ie locks, fenced, etc)

What % of equipment is not stored inside a structure overnight? or N/A (all inside)

Does the structure you store your equipment in most of the time (and overnight) have a central station

Burglar Alarm?Y..N Fire Alarm?Y..N

Other Notable Coverages You May Have For Any of Your Locations: (Please list)

If you have no more locations or buildings CLICK HERE to Skip to End of Form

LOCATION OR BUILDING #2

ADDRESS SAME AS ABOVE, OR Address, City, State, Zip:

Occupancy (Ex: Office, Store, Shop, Storage): Other Tenants Occupancies:

Surrounding Area Best Described as: City....Town....Rural --&-- Residential....Commercial....Open

Construction: # Stories: Square Feet Occupied by You: Total Sq. Feet Bldg:

Year Built: Is Bldg Stand Alone or Connected to Bldg's: Stand Alone..Connected # of Apartments?

Updates to Bldg : Electrical: Plumbing: Heating/AC: Roof: or All Within 10 Years?Y..N

Is Property Located in a Flood Zone?Y..N # of Feet from River?

PROPERTY PROTECTION

Is there a Central Station (24/7 Monitored) Burglar Alarm?Y..N Fire Alarm?Y..N

# of Miles to Fire Department? # Feet to Fire Hydrant? or None (check) Is Building Sprinklered?Y If Yes, What %?

LIMITS OF INSURANCE

Building Limit : Coverage is Replacement Cost If you want Actual Cash Value check here

Contents Limt : Coverage is Replacement Cost If you want Actual Cash Value check here

If you have no more locations or buildings CLICK HERE to Skip to End of Form

LOCATION OR BUILDING #3

ADDRESS SAME AS ABOVE, OR Address, City, State, Zip:

Occupancy (Ex: Office, Store, Shop, Storage): Other Tenants Occupancies:

Surrounding Area Best Described as: City....Town....Rural --&-- Residential....Commercial....Open

Construction: # Stories: Square Feet Occupied by You: Total Sq. Feet Bldg:

Year Built: Is Bldg Stand Alone or Connected to Bldg's: Stand Alone..Connected # of Apartments?

Updates to Bldg : Electrical: Plumbing: Heating/AC: Roof: or All Within 10 Years?Y..N

Is Property Located in a Flood Zone?Y..N # of Feet from River?

PROPERTY PROTECTION

Is there a Central Station (24/7 Monitored) Burglar Alarm?Y..N Fire Alarm?Y..N

# of Miles to Fire Department? # Feet to Fire Hydrant? or None (check) Is Building Sprinklered?Y If Yes, What %?

LIMITS OF INSURANCE

Building Limit : Coverage is Replacement Cost If you want Actual Cash Value check here

Contents Limt : Coverage is Replacement Cost If you want Actual Cash Value check here

If you have no more locations or buildings CLICK HERE to Skip to End of Form

LOCATION OR BUILDING #4

ADDRESS SAME AS ABOVE, OR Address, City, State, Zip:

Occupancy (Ex: Office, Store, Shop, Storage): Other Tenants Occupancies:

Surrounding Area Best Described as: City....Town....Rural --&-- Residential....Commercial....Open

Construction: # Stories: Square Feet Occupied by You: Total Sq. Feet Bldg:

Year Built: Is Bldg Stand Alone or Connected to Bldg's: Stand Alone..Connected # of Apartments?

Updates to Bldg : Electrical: Plumbing: Heating/AC: Roof: or All Within 10 Years?Y..N

Is Property Located in a Flood Zone?Y..N # of Feet from River?

PROPERTY PROTECTION

Is there a Central Station (24/7 Monitored) Burglar Alarm?Y..N Fire Alarm?Y..N

# of Miles to Fire Department? # Feet to Fire Hydrant? or None (check) Is Building Sprinklered?Y If Yes, What %?

LIMITS OF INSURANCE

Building Limit : Coverage is Replacement Cost If you want Actual Cash Value check here

Contents Limt : Coverage is Replacement Cost If you want Actual Cash Value check here

If you have no more locations or buildings CLICK HERE to Skip to End of Form

LOCATION OR BUILDING #5

ADDRESS SAME AS ABOVE, OR Address, City, State, Zip:

Occupancy (Ex: Office, Store, Shop, Storage): Other Tenants Occupancies:

Surrounding Area Best Described as: City....Town....Rural --&-- Residential....Commercial....Open

Construction: # Stories: Square Feet Occupied by You: Total Sq. Feet Bldg:

Year Built: Is Bldg Stand Alone or Connected to Bldg's: Stand Alone..Connected # of Apartments?

Updates to Bldg : Electrical: Plumbing: Heating/AC: Roof: or All Within 10 Years?Y..N

Is Property Located in a Flood Zone?Y..N # of Feet from River?

PROPERTY PROTECTION

Is there a Central Station (24/7 Monitored) Burglar Alarm?Y..N Fire Alarm?Y..N

# of Miles to Fire Department? # Feet to Fire Hydrant? or None (check) Is Building Sprinklered?Y If Yes, What %?

LIMITS OF INSURANCE

Building Limit : Coverage is Replacement Cost If you want Actual Cash Value check here

Contents Limt : Coverage is Replacement Cost If you want Actual Cash Value check here

If you have no more locations or buildings CLICK HERE to Skip to End of Form

LOCATION OR BUILDING #6

ADDRESS SAME AS ABOVE, OR Address, City, State, Zip:

Occupancy (Ex: Office, Store, Shop, Storage): Other Tenants Occupancies:

Surrounding Area Best Described as: City....Town....Rural --&-- Residential....Commercial....Open

Construction: # Stories: Square Feet Occupied by You: Total Sq. Feet Bldg:

Year Built: Is Bldg Stand Alone or Connected to Bldg's: Stand Alone..Connected # of Apartments?

Updates to Bldg : Electrical: Plumbing: Heating/AC: Roof: or All Within 10 Years?Y..N

Is Property Located in a Flood Zone?Y..N # of Feet from River?

PROPERTY PROTECTION

Is there a Central Station (24/7 Monitored) Burglar Alarm?Y..N Fire Alarm?Y..N

# of Miles to Fire Department? # Feet to Fire Hydrant? or None (check) Is Building Sprinklered?Y If Yes, What %?

LIMITS OF INSURANCE

Building Limit : Coverage is Replacement Cost If you want Actual Cash Value check here

Contents Limt : Coverage is Replacement Cost If you want Actual Cash Value check here

*
Have all Locations & Buildings been Entered?Yes No If NO, we will contact you for the remaining information.

LOSS INFORMATION - Past 3 Years

	CHECK HERE IF NO CLAIMS PAST 3 YEARS
Date of Loss	Description of Loss - Enter "NONE" in Description Line below if no losses.	Amount Paid

ADDITIONAL COMMENTS / INFORMATION

The above information is correct to the best of my knowledge. Check: Initials:
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QUESTIONS / HELP	Contact Office
Phone:	(412) 271-8888 Office Hours: 8:30am - 4:30pm EST Mon-Fri
Fax:	(877) 271-8898
Email:	insurance@thompsongusic.com