RCFE Commercial Property Quote

Facility Number *

Facility Address *

Address Line 1

Address Line 2

City

State

Zip Code

Year the Business Was Started *

Name on the Deed *

First

Last

Direct Phone Number *

Email Address *

Building/Dwelling Limit *

Other Limit *

Business Income (Loss of Use) *

Business Income (Choose Length) *

Value of Business Personal Property (i.e. Furniture, Supplies, etc.)? *

Construction Type *

Year Property Was Built *

Facility Square Footage *

Total Lot Square Footage *

Premises Fire Protection (Choose All That Apply) *

Sprinklers
Chemical Systems
Extinguishers

Is There a Mortgagee? *

Yes
No

Do you have an impound account? *

Yes
No

Please note: If you have an impound account, it is your responsibility to notify your mortgage company that you have paid the premium in full for your property insurance and discontinue any impound/escrow for insurance. Any funds that are dispersed from the mortgage company to the insurance company can be delayed for many months prior to the insurance company reimbursing you or the mortgage company.

Name of Mortgagee *

Mortgagee Address *

Address Line 1

Address Line 2

City

State

Zip Code

Is There a Second Mortgagee? *

Yes
No

Name of Second Mortgagee *

Second Mortgagee Address *

Address Line 1

Address Line 2

City

State

Zip Code

Is There a Third Mortgagee? *

Yes
No

Name of Third Mortgagee *

Third Mortgagee Address *

Address Line 1

Address Line 2

City

State

Zip Code

Have Any Wiring Improvements Been Made? *

Yes
No

What Year Were the Wiring Improvements Made? *

What Wiring Material Was Used (Aluminum, Copper, etc.)? *

What Specific Wiring Improvements Were Made? *

Have Any Roofing Improvements Been Made? *

Yes
No

What Year Were the Roofing Improvements Made? *

What Specific Roofing Improvements Were Made? *

Have Any Plumbing Improvements Been Made? *

Yes
No

What Year Were the Plumbing Improvements Made? *

What Specific Plumbing Improvements Were Made? *

Have Any Heating Improvements Been Made? *

Yes
No

What Year Were the Heating Improvements Made? *

What Specific Heating Improvements Were Made? *

Any Previous Claims in the Last Five Years? *

Yes
No

Describe Any Past Losses, Including Dates *

Has Coverage Ever Been Denied? *

Yes
No

Please Explain the Coverage Denial *

Current Carrier *

Expiration Date *

Premium (Optional)

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I consent.

Applicant's Signature *

THE ABOVESIGNED IS AN AUTHORIZED REPRESENTATIVE OF THE APPLICANT AND REPRESENTS THAT REASONABLE INQUIRY HAS BEEN MADE TO OBTAIN THE ANSWERS TO QUESTIONS ON THIS APPLICATION. HE/SHE REPRESENTS THAT THE ANSWERS ARE TRUE, CORRECT AND COMPLETE TO THE BEST OF HIS/HER KNOWLEDGE.