About Durkin & DeVries Insurance quotes for Boston, Massachusetts.

Is your current homeowner’s insurance company cancelling you upon your renewal?

Yes No

Is your home located in Barnstable, Bristol, Berkshire, Franklin, Hampshire, Hampden,
Dukes or Plymouth County?

Yes No

Personal Info

Required Fields are in Red

First Name:

Last Name:

Address

City:

State:

Zip Code:

E-mail:

Day Telephone:

Night Telephone:

Residence Information

Effective date of coverage:

Location of residence (if different from above):

Is this a Primary or Secondary residence:

Approximate year of construction:

Approximate square footage of the living area:

Construction type:

Any losses in the last 3 years:

Yes No

Number of families:

Smoke Detector:

Yes No

Is anyone living in the residence a smoker?

Yes No

Does the residence have a wood burning stove?

Yes No

Does the residence have a swimming pool?

Yes No

If yes, what type:

Do you own a dog?

Yes No

If yes, what breed?

When was the electricity updated?

When was the plumbing updated?

When was the heat updated?

How old is the roof?:

Coverage Information

Value of home, or amount of current insurance:

Important! The number you enter here applies to the structure only, and not the purchase price.

Personal property amount :

Personal Liability (each occurrence):

Medical Payments:

Deductible:

Endorsements:

Replacement cost options
(check all that apply):

Dwelling: Contents:

Protective devices
(check all that apply):

Smoke detectors:		Dead bolt locks:
Fire extinguisher:		Non-smoker:
Central Station Burglar Alarm:		Central Station Fire Alarm:
Police Station Direct Alarm:		Fire Station Direct Alarm:
Automatic Sprinklers:

Optional Coverages:

Earthquake Coverage:

Yes No

Flood Coverage:

Yes No

Scheduled Property
(enter an amount for all that apply):

Jewelry: vaulted?		Fine Arts:
Jewelry: vaulted?	Yes No
Golf Equipment:		Silverware:
Cameras:		Furs:
Musical Instruments:		Guns:

Comments or additional pertinent information: