303 Tamiami Trail S, Unit G, Nokomis, Florida 34275
(941) 484-4341

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Condominium / Homeowners Association Quote Request

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Binding Agreement

(Required) I understand that any policy changes and quote requests are effective only when I have received a written confirmation.*

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Your Contact Information

First Name:*

Last Name:*

Email Address:*

Phone Number:*

How would you like us to follow up with you?*

Email Phone

Condo/Association Information

Condo/Association Name:*

FEIN:

Condo/Association Address:*

Property Manager Name:

Property Manager Email Address:

Property Manager Phone Number:

Annual Sales / Receipts for Association:

Number of Employees:

Building Information

Year Built:*

Type of Construction:*

Square footage of each building:*

Number of Units:*

Number of Units held for rental:*

Does building have aluminum wiring?*

Yes No

Number of stories:*

Number of elevators:*

Do units have a fireplace?*

Yes No

Is grilling on balconies allowed?*

Yes No

What % of the buildings are sprinklered?*

Does the building have a central fire alarm system?*

Yes No

Is there a swimming pool on premise?*

Yes No

Is the pool gated and locked?*

Yes No

Has there been a loss in the last 4 years?
If yes, please provide dates and descriptions of loss or attach loss runs*

If your building is over 25 years old. Please list any updates to:
Roof
HVAC
Plumbing
Electrical

Required Coverage Limits

Building (Dwellings)

Building Personal Property:

Employee Dishonesty:

Optional Coverage (Check any that apply)

Business Auto D&O EPLI Water & sewer back-up Other

Questions or Comments

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This submission is a request. Insurance coverage changes and new coverages are not effective until we confirm that for you.

We will do our best to furnish a quote based on the information you provide. The more complete your information, the more accurate your quote will be.

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Contact Information:

CIA Carter Insurance Agency
303 Tamiami Trail S
Unit G
Nokomis, Florida 34275
Phone: (941) 484-4341
Fax: (941) 484-4322

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