John Manougian Insurance Agency, Inc.

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INSURANCE QUOTE REQUEST
Business Information
What is the Legal Name of your Association/Business?	Business Name
What is the Expiration Date of Current Policy?	Expiration Date
When do you Need a Proposal By:	Proposal Date
What is the Name of the Management Company?	Management Company Name
What is the Address of the Management Company?	Street
	City
	State
	Zip
What is the name of the Property Manager/Contact
What is the name of the Property Manager/Contact	Contact Name
What is the telephone number of the Property Manager/Contact
	Telephone Number
Property Information
Number of Buildings?	Buildings
Number of Units?	Units
Number of Stories?	Stories
Number of Elevators?	Elevators
Any parking structures? Please list number of levels and spaces.	Number of Levels and Spaces
What is the Construction Type?	Construction type
What is the Total Square Footage?	Total Square Footage
Number and type of amenities such as pools, clubhouses, and tot lots?	Number of Amenities
What is the Current Blanket/Replacement Value?	Current Blanket/Replacement Value:

Community Information
Addresses of all buildings:
Age of community (if built prior to 1990, please list any updates):
Individual HVAC Units?	Yes No
Central boiler system?	Yes No
List number of boilers if applicable:
Life Safety (check all that apply)	Full Sprinkler System Partial Sprinkler System Central Fire Alarm Local Fire Alarm Fire Extinguishers Hardwired Smoke Detectors Battery-operated Smoke Detectors Emergency Lighting Annunciator Panel Standpipes Other
List any water exposure (check all that apply)	Lakes Streams Ponds Ocean Other
Employee Information
If there are employees, please provide the number of full- and part-time employees, their duties, gross annual salaries (including any apartment allowance) and federal tax ID number:
Association Federal TaxID Number
Number of Full-time Employees
Number of Part-time Employees
Onsite Management/Clerical Total Payroll
Porters /Maintenance Total Payroll
Other Employee Information

Coverage Information
How much Umbrella/Excess Liability coverage is requested?
How much Employee Dishonesty/Crime coverage is requested (a minimum bond should equal three (3) month's worth of the annual operating expenses plus one (1) year's worth of reserves):
Any owned vehicles? Please provide the year, make, model and vehicle identification number (VIN) for each vehicle.
Please note that in order to provide a quote, we also will need the following information, which you may fax to 301-588-5177:
1) A five-year loss/claims history for the community
2) The insurance section of the association’s bylaws
Thank you. We appreciate your business. An agent will be in touch with you shortly. Please Note: Insurance coverage cannot be bound without a written binder from our office.