Phone: 602-222-8300
Fax: 866-512-2272
[email protected]
www.uistorage.com
1220 E Osborn Rd
Phoenix, AZ 85014
QUICK QUOTE FORM
Epic ID:
Today’s Date:
Effective Date:
Need By Date:
CUSTOMER INFORMATION
Legal Entity Name:
DBA:
Type of Business:
Corporation
Partnership
Sole Proprietorship
Contact Name:
Phone:
Years in Business:
Email:
Mailing Address (Street):
City/State/Zip:
Website:
Current Insurance Carrier:
Current Premium:$
Expiration Date:
Are you an association member?
Yes
No
Are you part of a franchise?
Yes
No
Do you offer tenant insurance?
Yes
No
AGENT INFORMATION
Agency Name:
Agency Address:
Agent Name:
Phone:
Email:
LOSS HISTORY
Has your insurance ever been cancelled, denied, or non-renewed?
Yes
No
If Yes, give reason:
Please list all losses:
DESCRIPTION:
None
DATE:
AMOUNT PAID:
$
$
$
LLC
FACILITY INFORMATION
Facility Address (Street):
City/State/Zip:
County:
General Liability Limit:
Medical Payment Limit:
Customer Goods Legal Liability Limit:
Sale and Disposal Liability Limit:
Employee Dishonesty Limit:
Number of Employees:
Identity Fraud?
Yes
No
Building and Business Personal Property Limit:
Equipment Breakdown?
Yes
Deductible:
No
Business Income (Estimated Annual Receipts):
What year was facility built?
Was it originally designed for self-storage?
Number of buildings:
How many stories?
Yes
No
Total building area (Gross square footage):
Number of rental spaces (inside building):
Open Lots RV/Boat:
Construction (exterior walls/partitions/roof, incl. metal gauge):
What type of access system do you use?
Video surveillance/monitoring?
Yes
No
Facility fully fenced/enclosed?
Yes
No
Individual door alarms?
Yes
No
Facility fully lighted at night?
Yes
No
Automatic sprinkler entire property?
Yes
No
Any vacant land?
Yes
No
Central alarm entire property?
Yes
No
If Yes, system monitors:
Office on premises?
Yes
No
Does Manager reside on premises?
Climate controlled?
Yes
No
If Yes, Number of Buildings
Does Manager do daily lock checks?
Yes
No
Does Manager/Facility keep keys to units?
Yes
No If Yes, Details:
Positive identification requested to rent spaces?
Yes
No If No, Details:
Do you need Hired and Non-Owned Auto Coverage?
Yes
No
Does your company own any vehicles?
Yes
No
Current Occupancy Rate:
Fire
Burglar
Yes
No
%
Any non-storage operations on site?
Yes
No
Describe:
ADDITIONAL INSURED/LOSS PAYEE/MORTGAGEE
Business Relationship:
Additional Insured
Loss Payee
Mortgagee
Other:
Name:
Address:
*Additional applications and underwriting information will be needed.