Property Insurance Questionnaire

4196 Herschel St Jacksonville, Florida 32210 800-340-4729 904-387-9798 maryw@jlkirby.com

Big Brothers Big Sisters Property Insurance Questionnaire

Thank you for completing this questionnaire. It is being returned to John L Kirby & Associates for immediate processing so we may provide your quote. Your progress will be saved at any point, to complete the questionnaiire at a later time you must restart from the same computer using the same browser. Your data will be saved for 5 days. If you have any questions concerning this questionnaire, please call us for help.

Agency Name *

Address *

Address 2

City *

State *

Zip *

Contact Person *

Email *

Expiration date of you property insurance.

Date

Do You:

Own the building Rent/Lease

Is the address the same as above?

Yes No

Address

Address 2

City

State

Zip

Provide the amount of insurance for your building.

Provide the square footage of the entire building.

Provide the amount of insurance for you office furniture and equipment.

Provide the square footage of the space you occupy.

Do you occupy the entire building?

Yes No

Please provide he construction of the building. (i.e. brick, concrete block, wood, etc.)

Number of stories in the building.

Is the building over 25 years of age?

Yes No

Please advise when the following have been updated.

Electrical

Roof

A/C

Heat

Plumbing

Do you have burglar alarm?

Yes No

Does if notify the police department?

Yes No

Do you have a fire alarm?

Yes No

Does it notify the fire department?

Yes No

Please advise if there are any special coverage needs: