Condo Questionnaire Name Name (Spouse) Date of Birth Date of Birth (Spouse) Phone Number Email Address or Other Contact Location Address (Please also list mailing address if different) (If you've lived at this address less than 5 years, please list prior address also) Property Info: Year of construction Style of home (1 storey, 2 storey, etc) Above ground square footage Below ground construction (Basement/Slab/Crawl: If basement, % finished:) Exterior construction # of Baths (# of full & # of 1/2) Central Air YesNo Fireplace (Yes/No, Gas/Wood/Wood Stove) Flooring: (% of each type) Age & type of heating Age & type of electric (Circuit Breakers/Fuses) Security or Sprinkler System (If yes, what?) Repairs Needed Please list type & value of Additions & Alterations to the original construction Current Insurance Info: Current Coverages (Include company, effective date, coverages, deductible & endorsements) Additional Info: According to your bi-laws, what part of your unit are you responsible to carry coverage on (other than your contents)? Dwelling Coverage Desired Personal Property Coverage Desired (Value to replace ALL contents with NEW ones) Contents that you are specifically concerned about replacing (ie Jewelry, Guns, antiques, artwork, etc) List type & Value Purchase Date # of consecutive years you've carried a homeowner-type policy? (Including home, condo, mobile home & tenant) Property Claims in the last 5 years (List when & what) Smoker/Non-Smoker (All residents) Bankruptcy in the last 5 years? (If yes, when?) Is there a pool, hot tub or trampoline on your property? (If yes, what?) Do you have any pets? (If yes, what breed?) Business conducted in your home? (If yes, what?) Deductible options you would consider Additional Insured Do you have any toys? (ie boat, motorcycle, ATV, snowmobile, golf cart, RV, etc) If you have a copy of your curent "Declaration Page", please forward that to us as proof of prior coverage and to use for comparison purposes. Submission of information for a quote in no way binds coverage. Personal information will be used solely for underwriting purposes. Submission of information gives the Gary J Bach Agency permission to run all reports necessary to quote accurate insurance premiums.