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A Service of Simons
Insurance Agency
12743 Bellflower Blvd.
Downey, CA 90242
Toll Free: 888-646-2366
Local Phone: 562-803-3101
Fax: 800-346-2245
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Commercial Property Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Name
Business Name
Property Address
City
State: (Must be California)
Zip Code
E-Mail (REQUIRED)
E-Mail again for accuracy
Phone
Fax (optional)
Dwelling Information
Year Building Built
Building Square footage
Ocupancy
Owner      Tenant
Occupancy Type
(describe entities & and number of units, such as "4 unit apartment" or "2 offices and barber shop", etc.)
Type foundation
Slab
Crawlspace over slab
Pier & Post
Other (list in remarks)
Type finished basement, if any
None      Full
25%      50%       75%
Type Roof
Shingle      Wood Shake
Tar/Gravel      Spanish Tile
Metal      Other
Type of Siding
Brick      Vinyl
Wood      Aluminum
Number of stories
One      Two
Three      4 or more
# of feet to nearest fire hydrant
# of miles to nearest fire station
Currently Insured?
Name of Carrier & how long insured?
Yes      No
Prior Claims?
Describe claims in detail
Yes      No
Plumbing type
Copper      Galvanized
Mixed (Copper/Galvanized)
Coverages
Building Cov. $
Contents $
Liability Cov. $
Deductible $
($250, $500, $1,000, etc.)
Other Coverage/Remarks
(describe any extra coverages needed such as business interruption, robbery, computers, etc.)
Send my quotation via:
E-Mail                  Fax
Regular Mail      Call me by Phone!
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