Utilize our One-Step Online Quote Request Forms to get a pricing indication for your insurance need.



VACANT PROPERTY QUOTE
Please fully complete the following data form, and simply click the "Submit" button and we will contact you with an insurance quotation.

Please note we cannot accept binders or policy changes by email, only by phone during normal working hours.



VACANT PROPERTY INSURANCE

 

First Name:
Last Name:
Email Address:
Phone Number:
Fax Number:
PROPERTY INFORMATION

Property Address:

Property City:
Property State:
Property Zip Code:
How Many Months Has The Property Been Vacant?
What Date Did The Property Become Vacant?
Why is the Property Vacant?
What Steps have you taken to make sure the Property is safe and secure?
Give a Good Description Regarding the Physical Condition of the Property?
How Many Months Will The Property Be Vacant?
How Many Units Are In The Building:
Year Built:
Date You Purchased The Property:
Garage Description:
  
How Many Stories:
If Two Stories, Ground Floor Square Footage:  
Total Square Footage of The Building:  
Construction Type:
  
Roof Type:
  
Roof Updated:
 yes no  
If Yes, Year Roof was Updated:
Property Topography:
  
Protection Distance:
Is The Building in the Brush?
 yes  no  
Is there a Brush Hazard within (1) mile of The Building?
 yes no  
If yes, has the Brush been cleared by 250 feet from all sides of The Building?
 yes no  
Smoke Alarm:
 yes no
Fire Extinguisher:
 yes no  
Deadbolts:
 yes no
Electrical Updated:
Circuit Breakers:
 yes no
Copper Wiring:
 yes no
Heating - Air Conditioning, How Old?:
Heating - Air Conditioning, Thermostatically Controlled?:
 yes no 
Energy Source: 
Heating - Air Conditioning, Central?
 yes no 
Plumbing Updated:
 yes no
If Yes, Year Plumbing was Updated:
Copper Plumbing:
 yes no  
Interior Automatic Fire Sprinklers: 
Theft Alarm:
Fire Alarm:
Earthquake Zone:
Earthquake Retrofitted: 
  
Fire District:
Current Insurance Company:
Any Dogs on the Property:
 yes no
If Yes, Number & the Breed of Each Dog:
  
Any Other Pets-Animals on the Property:
 yes no  
If Yes, Number & Description of Each Pet-Animal:
Losses-Claims in the last 5 years: 
  
If Yes, Date, Amount Paid & Description of Each Loss-Claim 

 

COVERAGE INFORMATION
Dwelling Amount (Coverage A):

Other Structures (Coverage B):
Personal Property (Coverage C):
Loss of Use (Coverage D):
Premise Liability (Coverage E):
Policy Deductible:
If EarthQuake insurance is requested, select Deductible Percentage %:
  
Please press the Submit Button ONCE.
Then wait for online confirmation of your request.
Thank you for your interest.




17821 E 17th St, Suite 100, Tustin, CA 92780 :: LICENSE #0543173