Smith Insurance Associates, Inc.

REQUEST A QUOTE - COMMERCIAL ACCOUNTS

NAMED INSURED:

ADDRESS:

CITY:

STATE:

ZIP CODE:

NUMBER OF UNITS:

NUMBER OF BUILDINGS:

TOTAL SQUARE FOOTAGE:

YEAR BUILT:

CONSTRUCTION TYPE:

TOTAL PROPERTY VALUE:

RENTAL INCOME:

CURRENT CARRIER:

CURRENT PREMIUM:

RENEWAL DATE OF CURRENT POLICY:

LOSS HISTORY:

CONTACT NAME:

MANAGEMENT COMPANY:

TELELPHONE:

RECIPIENT FAX:

EMAIL ADDRESS:

REFERRED BY:

NOTES/COMMENTS:

Upon receipt of the form, you will be asked to provide the following information in order to obtain a quote for your association:

A current, three-years Loss Run from current insurance company
A site plan of the development

Disclaimer

The Smith Insurance Associates, Inc. website provides a general description of the coverage(s) recommended for consideration. It does not contain all the provisions, conditions, limitations and exclusions applicable to those insurance contracts. In all cases, the provisions of the contracts are applicable and the contracts themselves should be consulted to resolve questions of coverage.

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We strive at all times to preserve the privacy and security of all clients and visitors to our site. All information disclosed in application forms or by email will be treated with strictest confidence and will not be shared with other companies, except where necessary to obtain an insurance quote for the client. Tracking of page accesses is used for statistical purposes only. This site does not presently use cookies.