Name
Phone







6650 Reseda Blvd
Suite #108
Reseda, CA 91335

contact@gisinsure.com
Apartment Building
 

 

First Name:
Last Name:
Mailing Address:
Mailing City:
Mailing State:
Mailing Zip Code:
Phone Number:
Fax Number:
E-Mail Address:
Who Refereed You To Our Site?

Property Information
 

Property Address:

 

Property City:
Property State:
Property Zip Code:
How Many Units In The Building?
How Many Units In The Building Are Vacant?
Year Built:
Date You Purchased The Property:
Construction Type:  
How Many Stories:
If Two Stories, Ground Floor Square Footage:  
Total Square Footage of The Building:  
Is There A Basement? yes  no  
Garage Description:  
Roof Type:  
Roof Updated: yes no  
If Yes, Year Roof was Updated:
Does The Dwelling Have A Pool? yes  no  
If Pool, Is It Fenced? yes  no  
If Pool, Is There A Diving Board? yes  no  
If Pool, Is There A Slide? yes  no  
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
Does The Electrical Circuit Box Have Copper Wiring? yes no
Heating - Air Conditioning, How Old?:
Heating - Air Conditioning, Thermostatically Controlled?: yes no 
Energy Source: 
Heating - Air Conditioning, Central? yes no 
Has The Plumbing Been Updated? yes no
If Yes, Year Plumbing was Updated:
Copper Plumbing: yes no  
Does the Building Have 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):
Business Property (Coverage C):
Loss of Use (Coverage D):
Premise Liability (Coverage E):
Policy Deductible:
If Earthquake Insurance is Requested, Select Deductible Percentage %:  
Building Replacement Cost Coverage: 

yes no