HO and DP Quote Application HO DP Application for Quote Agent Name/Agency: * Agent’s Email * Insured’s Name: * Insured’s Mailing Address: * Insured’s Mailing City * Insured’s Mailing State * Insured’s Mailing Zip * Insured’s SSN: 123-45-6789 Insured’s DOB * mm/dd/yyyy Type Of Quote * DP1DP2HO8HO8 w/waterHO3SeasonalVacantBuilders Risk Mortgagee Name Mortgagee Address Loan # Risk Location Address: * Risk Location City * Risk Location County * Risk Location State * Risk Location Zip * Construction Type * FrameMetalCinder BlockMobile HomePre-Fab / Modular Year Built * yyyy Roof (Age & Composition * Square Foot * Market Value * example: $100,000 Occupancy * PrimarySecondaryTenantVacant Protection Class * 12345678910 A: Dwelling Amount of Coverage: * B: Other Structures Amount of Coverage: * C: Personal Property Amount of Coverage: * Loss of Use: Amount of Coverage: * Premises Liability: Amount of Coverage: * Underwriting Comments / Additional Information: Underwriting Questions: 1. Is risk occupied by more than 1 family? * YesNo 2. Is business conducted at risk location (if yes, cannot provide a quote.) * YesNo 3. Is risk located on more than 10 acres of land? * YesNo 4. Is there a body of water (i.e. lake, pond, creek) on the premises? * YesNo 5. Is there a wood burning stove (is yes, cannot provide a quote.) * YesNo 6. Has risk been cancelled, non-renewed, or declined by another company? * YesNo 6a. If yes, please explain. 7. Has insured filed bankruptcy in last 3 years? * YesNo 8. Any previous fire losses? * YesNo 8a. If yes, please explain. 9. Any previous losses in the last 5 years? * YesNo 9a. If yes, please explain. 10. Have there been any updates to plumbing & electrical? * YesNo 10a. If yes, please list year: Plumbing 10b. If yes, please list year: Electrical 11. Does risk have central heat & air? * YesNo 11a. If no, what is used for heat source? 12. Is insured gainfully employed? * YesNo 13. Please advise how many years you have known the applicant? 14. Is this a new purchase? * YesNo 14a. If yes, what is the purchase price? 15. If not a new purchase, is risk currently insured? (Type of policy form and dates) * 16. Is property managed by a management company or someone other than the insured? * YesNo 16a. If yes, who? Submit If you are human, leave this field blank. Δ{{#message}}{{{message}}}{{/message}}{{^message}}Your submission failed. The server responded with {{status_text}} (code {{status_code}}). Please contact the developer of this form processor to improve this message. Learn More{{/message}}{{#message}}{{{message}}}{{/message}}{{^message}}It appears your submission was successful. Even though the server responded OK, it is possible the submission was not processed. Please contact the developer of this form processor to improve this message. Learn More{{/message}}Submitting… If you have additional files, photos, loss runs, etc.… that you would like to submit, please email to quotes@owensins.com. Share this: Share on X (Opens in new window) X Share on Facebook (Opens in new window) Facebook