Add Rental Property

What is the date you would like this policy to be effective:

What is the complete address of the property:

Who is the legal title holder of the building:

If a building is titled under a bank trust, that bank trust must be added to the policy.

How many units are rented out:

When does the lease for your tenant expire:

Please tell us about the building.

Year built:

Replacement cost (amount of building coverage desired):

Replacement cost is the amount that it would take to replace the building in the event of a loss.

Number of stories:

Total square feet:

Type of construction:

Click here if you picked Other

Please explain:

Does this rental property have smoke detectors:

Does this rental property have fire extinguishers:

Does this rental property have a central station alarm:

Is this rental property within 5 miles of a full-time fire department:

Is this rental property within 1,000 feet of a fire hydrant:

Does this property have a swimming pool:

Click here if you picked Yes

Is the pool in ground or above ground:

Do you have a fence around the entire area of the pool:

Did you add any buildings for pool equipment, etc:

Is there a diving or spring board:

Is there a slide:

How deep is the pool:

Do you have a trampoline:

Do you have a loan on the property:

Click here if you picked Yes

Please list the name and complete address of the mortgage company:

Do you need evidence of property coverage prepared for the mortgage company:

Click here if you picked Yes

Please provide the fax number or email address for the recepient of this form:

What liability limit would you like to apply:

What deductible do you want on this property:

Additional Information

Comments or Additional Information:

Did You Know?

If this building is vacant, your coverage could change and become more limited putting you at additional risk.

Would you like someone to contact you about this:

Customer name or code:

Thanks for providing this information . If we need to contact you for additional information, we will send you a message through the secure Message Center. You can view a copy of this request by clicking on File Cabinet. You will receive an email confirming this request made on Friday, May 18, 2012 - 10:32am.

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Click here to view the Terms & Conditions.

Umpqua Insurance

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