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Commercial EQ Quote Form  
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To request Commercial EQ Quote, please complete the form below.
Bold fields are required
Producer Name

 

Email:
Producer Phone Number

 

Producer Fax Number

 

Prospect Information
Prospect Name

 

Mailing Address

 

City, State, Zip

 

Phone# for Inspections

 

Building Information
Address

 

City, State, Zip

 

Building Occupied As

 

Number of Units

 

Year Built

 

Total Square Feet in Building

 

Number of Levels

 

Construction Type

 

Parking Relative to Building

 

Building Replacement Value

 

Contents

 

 
Please send in Multiple Building Schedule and Report Total Insurable Value for 2 or more buildings.
Business Income/Extra Expense

 

Loss of Rents/Income

Please report annual figures only. Carriers do not offer Actual Loss Sustained Coverages.

Other Coverages available

Other Property Coverage:

 ***Foundations, Basements, Fences, Driveways, Retaining Walls, Swimming Pools, Signs, Glass that is part of the property.

Building Code and Upgrade

 

Flood

 

EQSL

 

Mold (Sublimit)

 

Current EQ Carrier

 

Current Coverage

 

Target Premium

 

Expiration or Start Date

 

Remarks

 

    

  

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