Condominium Unit Owners Insurance Survey - IRMS Insurance and Risk Management Services

Contact Information

Client Name

Contact Name

First Last

Phone Number

Email Address

Client Information

Date of Birth

Occupation

Spouse or Roommate's First Name

First Last

Spouse or Roommate's Date of Birth

Spouse or Roommate's Occupation

Who owns the property to be insured? (i.e. Individual, Trust, Corporation, etc.)

What is the name of the Association?

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mobile Phone Number

Phone

Email Address*

How did you find out about IRMS?

Other (If other please specify)

How quickly do you need your quotation?

Have you, your spouse, or your roommate ever been involved in a bankruptcy or foreclosure or convicted of arson or fraud?

If yes, provide details

When do you want your policy to be effective?

How long have you lived at your current address?

List the insurance company that currently insures the property to be insured.

List the expiration date of your current policy (mm/dd/yyyy)

Have you reported any claims in the past 5 years under any homeowner's policy in any state?

If yes, provide details

Property Information

Address of the Property to be Insured

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

What is the dwelling description for this property?

What is the occupancy of this property?

If seasonal, please provide the name and phone number of the person or company watching your unit.

If seasonal, which months during the year do you occupy the property?

Do you rent the property?

If you rent the property, which months during the year do you rent the property?

If you rent the property, what is the minimum amount of time (week/months/annually) each renter will occupy the property?

Is a business operated at this property?

If yes, provide details

Which Fire Department would respond to this property?

Do you own any watercraft or recreational vehicles?

If yes to above provide the Year, Make and Model.

Do you have any pets or other animals living at this property?

What is the type and breed of the animal?

Have there been any instances of animals biting anyone?

In what year was the property built?

How many floors does this property have?

Which floor is the unit located on?

How many units are in the buildings?

What is the foundation type?

What is the shape of the roof?

What is the roof material?

If this property is more than 20 years old, when is the last time you renovated the roof?

If this property is more than 20 years old, when is the last time you renovated the plumbing?

If this property is more than 20 years old, when is the last time you renovated the electrical wiring?

If this property is more than 20 years old, when is the last time you renovated the Heating/Air Conditioning Unit?

What is the year of the hot water tank?

Do you have any structures that are not attached to the main property?

Cabana
Storage Unit
Boat Lift

Check all that apply to this property

Pool
Jacuzzi
Hot Tub
Spa
Diving Board
Slide
None of These

If you have a pool, do you have a protective barrier surrounding your pool?

Fence
Pool Enclosure
No

If you have security devices in your property, check all that apply.

Do you have any jewelry, fine arts, silverware, furs, etc. that need to be scheduled?

Do you have a Flood Policy in place?

Do you have a Flood Elevation Certificate for this property?

Do you have completed mitigation forms for this property

Do you own any other properties we are not insuring?

Replacement Cost Information

Replacement cost of your additions and alterations coverage

How many square feet of air-conditioned space does this property have?

Replacement cost of the contents to be insured

Kitchen Design:

Builder's Grade
Custom
Designer

How many bathrooms does this property have?

What is the construction type?

Bathroom Design:

Builder's Grade
Custom
Designer

Purchase price of your property

Was this home purchased in a foreclosure or short sale?

Please include the percentage of each type of flooring in the unit (must add up to 100%)

% of Carpet

% of Ceramic Tile

% of Marble

% of Wood

List Other Types (with %)

Any Additional Comments

By Checking this Box, you certify that all information provided is accurate.*

Are you a current client of IRMS?*

If yes, who is your agent?*

If no, have your spoken to any of the following agents?**

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