Lobosco Insurance Group, LLC

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Self-Storage Building, Facility Insurance Quote Form

First & Last Name:  
Street Address:  
City, State & Zip:  
E-Mail Address:  
Telephone:  
Fax:  

Current Insurance Information
Insurance Company Name:  
Policy Exp. Date:  
Amount Insured for:  
Mortgage Amt:  
Premium Amt:  
Term:  
Any Claims in Last 3 years?  
# of Buildings:
In City Limits?:
Exterior Walls:
Ceiling Joists:
Roof:
Sprinklered:
Year built:          Sq. ft. of buildings:
Annual Rental Income (based on 100% occ.)
Replacement Values of all buildings ($):
Replacement Value Business personal property:
# of miles from fire dept:

Claims History of last 5 years:

Give any additional information that may assist us in providing you with an accurate self-storage insurance quote:
Note: By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentially viewed by unauthorized others. We will only use this information for insurance quoting purposes and not distribute to other parties.

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