Add A Vacant Home

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

What is the complete address of the property:

Who is the legal title holder of the building:

Indicate the name on the title including any bank trusts.

How long will this building be vacant:

Will this property be used by others:

Click here if you picked Yes

How will this property be used by others:

Please tell us about the building

What year was it 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.

How many stories does this building have:

What is the total square feet of the building:

Type of construction:

Click here if you picked Other

What is the type of construction:

Does the building contain smoke detectors:

Does the building contain fire extinguishers:

Does the building have a central alarm station:

Is the building within 5 miles of a full-time fire department:

Is the 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 deepest part of the pool:

Do you have a trampoline:

Do you have a loan on the property:

Click here if you picked Yes

What is the name and complete address of the mortgage company:

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

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 your home is damaged from flood waters, you might not be covered.

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 found in File Cabinet. You can view a copy of this request, and a copy of your ID card, by clicking on File Cabinet. You will receive an email confirming this request made on Friday, May 18, 2012 - 10:32am. Your primary contact person in our office is .

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