Partner – M&P Commercial Intake Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name of Agent Submitting Quote *FirstLastAgent Phone Number *Agent Email Address *Which Agency should this be written under?Macdonald & Pangione Ins. Agency IncR C Briggs Insurance AgencyBarry J Kittredge Insurance AgencyClient InformationWhat's your reason for seeking flood insurance?" *Please select oneBuying or recently bought a new buildingReplacing my existing policyRefinancing a loanNew flood map, lender now requires itJust want to have coverageOther (please specify in notes)When do you need the policy to start? *Named Insured (Company)If a legal entity owns the building, please provide its name. If the building is owned personally, enter your first and last name. If you do not have a legal entity set up, you may skip this question.What type of entity owns the property?IndividualLimited Liability Company (LLC)CorporationTrustJoint VenturePartnershipOther (please specify in notes section)Primary Contact *FirstLastSecondary ContactFirstLastYour Phone Number *Your Email Address *Now, let's get some specific details about the property you want to insure.Property Address for Coverage *Address Line 1City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePlease Enter Your Local County NameIs your mailing address the same as this property? *YesNoPlease provide your mailing address *Address Line 1City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIs your property currently under construction or planned to be built? *NoYesFor the property under construction, please provide the following: Click or drag a file to this area to upload. 1) A Google Maps link and the latitude and longitude coordinates of the property. 2) Photos of all external sides of the property, or architectural plans if available. 3)If you have an Elevation Certificate, please include that as well.What type of property are you looking to insure? *Please select oneOffice buildingMercantile / RetailRestaurantWarehouseStorage UnitApartment complex or Co-op BuildingHotel, Motel or InnMixed building Use (residential and something else)Gas stationCar washCommercial CondominiumsManufacturingEntire residential condo building – RCBAPOtherYou selected 'Other.' Please describe the type of property you want to insure: *How is the building primarily used? *Please select oneI own it and rent it out to others (not as a residence)I own it and work out of it (not as a residence)I own the entire building of a Apartment or CoopI own a Building that has mixed use some residental some commerical in the same buildingRenting: contents coverage only.I own a unit in a commercial condominiumRCBAP – Entire Residential Condo BuildingIs this condo building at least 75% residential? *YesNoWhat is your role in relation to the condo association? *please select onePresident of the Condo BoardSecretary of the Condo BoardTreasurer of the Condo BoardBoard MemberConcerned Unit Owner (not on the board)Property ManagerOther (please specify)Insurance agentWhat is the number of stories in the condo building for which you're seeking a quote? *Please specify your reason for filling out this form and describe your relationship to the HOA. *Property Manager Information: The name of your management company: *Property Manager Information: Your name as the property management representative: *Property Manager Information: Your phone number for contact: *Property Manager Information: Your email address for contact: *How many residential units are there in this specific condo building? *Please enter the total number of unit is in this buildingAre there multiple buildings in this condo complex? *NoYesHow many separate buildings are in the condo complex? *Do you have a site map of the condo complex? If yes, please upload it here. Click or drag files to this area to upload. You can upload up to 10 files. How many residential units are there in this specific apartment building? *Please enter the total number of unit is in this buildingAre there multiple buildings in this apartment complex? *NoYesHow many separate buildings are in the apartment complex? *Do you have a site map of the apartment complex? If yes, please upload it here. Click or drag files to this area to upload. You can upload up to 10 files. What is the mixed-use ratio of the building? *please select one25% Residential, 75% Commercial50% Residential, 50% Commercial75% Residential, 25% CommercialYou selected 'Mixed-use' Please describe the type of property you want to insure: *How many units are in this mixed use building? *Please enter the total number of unit is in this buildingWhat year was the building constructed? *How much coverage do you need for the building itself? *Please select one$100,000$150,000$200,000$250,000$300,000$350,000$400,000$450,000$500,000$600,000$700,000$800,000$900,000$1,000,000More then $1,000,000How much additional building coverage do you require over $1,000,000?How much coverage do you want for your personal belongings inside (like furniture, electronics, clothing)? *Please select oneNone$50,000$100,000$150,000$200,000$250,000$300,000$350,000$400,000$450,000$500,000$550,000$600,000$650,000$700,000$750,000$800,000$850,000$900,000$950,000$1,000,000More then $1,000,000How much additional contents insurance coverage do you require over $1,000,000?How much loss of business income coverage do you want? *Please select oneNone$50,000$100,000$150,000$200,000$250,000$300,000$350,000$400,000$450,000$500,000$550,000$600,000$650,000$700,000$750,000$800,000$850,000$900,000$950,000$1,000,000More then $1,000,000How much extra business coverage do you require over $1,000,000?Deductible *$5,000$10,000$25,000$50,000Do you need insurance for other structures on your property? *YesNo Has the property experienced flood damage? *Please select oneNoYESI don't know but will ask Seller When did the flood loss occur? *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What was the total cost of damage, including deductible, contents, and building? *Have there been multiple flood losses on this property? *YesNoDid you file a claim? *YesNoWhat type of foundation does your building have? *Please select oneSlabCrawl spaceSplit LevelBasementElevated BuildingWhich description best fits your basement foundation? *Please select oneFully underground on all sidesWalkoutWhich description best fits your elevated foundation? *Please select oneElevated Open – no enclosureElevated partially enclosedElevated with garage ONLYElevated with a garage and additional roomElevated with the area completely enclosedWhich description best fits your crawl space foundation? *Please select oneCrawl space fully or partially undergroundCrawl space Above groundWhat best fits your above ground crawl space? *Please select oneCrawl space without enclosureCrawl space partially enclosedCrawl space with enclosureHow many floors does the building have? *Please select one12345 or moreHow many floors above ground does the building have? (Do not include the basement.)How many floors 5 or more levels does the building have? *What is the total square footage of the structure? *What material is the building's frame constructed from? *Please select oneWood FrameBrick or MasonrySteel FrameConcreteMobile home with Tie DownsYou've Choose 'Mobile Home/Manufactured Home': Review the descriptions to confirm your choice.Mobile Home: “A mobile home is built on a chassis and can be moved. It’s prefabricated and transported to its location.” –//– Manufactured Home: is the same as a mobile home, built on a steel frame with wheels for mobility. –//– Modular Home: “A modular home is made in sections at a factory and assembled at a fixed site. It’s not designed to be moved after assembly.”Is the mobile home / manufactured home anchored to a permanent foundation? *YesNoHas the mobile home had its wheels and tires removed? *YesNoHow is the mobile home secured? *Please select oneAnchored per manufacturer's guidelinesAnchored to floodplain management standardsSecured with ties to ground anchorsNot anchored (uninsurable)What is the serial number of the mobile home? *If unknown, enter ‘TBD’ and you can provide it before finalizing the policy.What type of garage does the property have? *Please select oneNo GarageAttached GarageDetached GarageBuilding over GarageGarage is the basement foundationFirst floor parking at ground levelHow many cars can your garage hold?Please select one12345 or moreDoes your property have any rooms with floor-to-ceiling wood paneling? *Please select oneNo, there is no wood paneling.Yes, one small room has wood paneling.Yes, one medium to large room has wood paneling.Yes, two or more rooms have wood paneling.What flood zone is your property located in?Please select oneZone AEZone XZone VEZone AZone VZone AOZone AHIf you’re unsure about your flood zone, simply select Zone AE, and your flood nerd will verify your correct flood zone for you. This ensures you get accurate coverage without the guesswork.Additional InformationPlease share any other details or notes about your property that you think are important for your insurance coverage.File Upload Section Click or drag files to this area to upload. You can upload up to 10 files. Please upload any relevant documents or images here. This can include photographs of the property, architectural drawings, an Elevation Certificate, documentation of your flood zone, lender correspondence, prior insurance policies, or any other pertinent information.I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.Yes I agree.SubmitSave and Resume Later Your form entry has been saved and a unique link has been created which you can access to resume this form. Enter your email address to receive the link via email. Alternatively, you can copy and save the link below. Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted. Copy Link Email * Send Link
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