ADP Barlow Insurance - Form Display

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COMMUNITY ASSOCIATION - INSURANCE QUOTE REQUEST
	To automatically submit your request for Business Insurance to our company, please fill out and submit the following form and select Submit. Your request will immediately be sent to the underwriting team whom will be in contact once they’ve had an opportunity to review your information. If you need to contact us directly, please refer to the contact us page on this website.

General Information

Type of Community

Chose the Association that "best" decribes

Management Company Name

Name of Community

Street Address

Physical Location of Property - If No Actual Street Address, Main Roads or Cross Street

City

State

ZIP

Number of Units

Number of Buildings

(Do NOT Include Clubhouse, Maintenance or other Structures)

Number of Units per Building

(If Varied - list how many bldgs of each)

Number of Stories per Building

(If Varied - list number of 3 story, 4 story etc)

Clubhouse
	Yes No

If Yes, Describe

Square Footage: List Amenities - Weight Room, Kitchen, Etc

Pool
	No Yes Indoor Outdoor Baby Jacuzzi

Depth of Pool(s)

List Shallow to Deepest

Property Coverage

Do You Know Total Insured Value of Property
	Yes No

If Yes, Explain:

Provide Most Recent Appraised Value

Do You Know Total Square Footage of All Bldgs?

Please list square footage of all bldgs

Construction Type
	Frame Masonary Joisted Masonary Brick Vaneer Stucco EIFS

Roof Type
	Gable Flat

General Liability
	$1M per Occurence $2M Aggregate

Directors & Officers
	Include Management Company

Fidelity Bond
	Include Management Company

Excess Liability (Umbrella)
	$5M $10M $15M

Please Describe Any Other Information About Your Association Below. Be Sure To Include All Relevant Information as Well as Detailing Any Special Requests

Current Agent

Current Carrier(s)

List Line of Coverage & Carrier

Association Specifics We Should Know

Proposal Due Date

Enter Your Name And How You May Best Be Reached

First Name

Last Name

Work Phone

Home Phone

E-Mail

If You Have Any Additional Questions Or Comments, Please Enter Them Below

Comments

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