Earthquake Insurance Information

    1. Vesting/Ownership (Name as it will appear on the policy) (required)

    2. Contact Email (required)


    3. Contact Phone Number (required)

    4. Mailing Address (required)

    5. Location Address (required)

    6. Year Built


    7. Square Footage (building area only, not garage)?

    8. Construction Type (Frame, Reinforced Concrete Block, Tilt-Up, other-please specify)

    9. Number of Buildings


    10. Number of Stories?


    11. Number of Units?

    12. Occupancy Type per Building (Apartments, Commercial, etc)

    13. Type of Parking

    Garages or Carports


    Attached or Detached

    (if attached, please specify if Tuck Under, Subterranean, or Under-Building)

    14. Any prior earthquake claims? if yes, describe the loss(es), list the amount paid and date of loss:

    15. Building Limit:


    16. Amount of annual rent

    17. Personal Property (if any: rental office, furnished units ...)

    18. Current Carrier:


    19. Expiration Date:

    20. General Message