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



EARTHQUAKE INSURANCE 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.



EARTHQUAKE INSURANCE

First Name:
Last Name:
Email Address:
Business Name:
Mailing Address:
Mailing City:
Mailing State:
Mailing Zip Code:
Phone Number:
Fax Number:
PROPERTY INFORMATION

Property Address:

 

Property City:
Property State:
Property Zip Code:
Occupancy Type:
Building Type:
Year Built:
How Many Stories:
Total Square Footage of the Building:
How Many Units Are In The Building:
Garage Description:
Construction Type:
Foundation Type:
Nature of Sub-Soil:
Topography:
Roof Type:
Roof Updated:
 yes no
If Yes, Year Roof Updated:
Any Erosion in the Area?
 yes no
Any Below Ground Parking?
 yes no
Any Soft First Story or Tuck Under Parking?
 yes no
Protection Distance:
Is the Building in the Brush Area?
 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 Detectors:
 yes no
Fire Extinguishers:
 yes no
Electrical Updated:
Circuit Breakers:
 yes no
Heating - Air Conditioning, How Old?
Plumbing Updated:
 yes no
If Yes, Year Plumbing Updated:
Copper Plumbing:
 yes no
Automatic Sprinklers:
Fire Alarm:
Earthquake Retrofitted or Bolted:
Current Insurance Company:
Losses-Claims in the last 5 years:
If Yes, Date, Amount Paid and Description of each Loss-Claim

COVERAGE INFORMATION

Building Coverage:

 

Other Structures Coverage:
Contents Property Coverage:
Loss of Use Coverage:
Earthquake Deductible:
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