For a
Homeowners
insurance policy quote on new construction, simply fill out the form below and click the submit button. One of our agents will contact you to review a personalized quotation within 24 hours. If you have any questions regarding this form or regarding coverage in general, please feel free to
contact us
.
Personal Info
First Name:
Last Name:
Address
City:
State:
Zip Code:
E-mail:
Telephone:
Fax:
Best time to call:
Construction Unit Information
Please insert numbers in the boxes below
Kitchen:
Dining Room:
Living Room:
Den/Study/Office:
Family/Recreation Room :
Bedroom(s):
Bathroom(s) (3 or more fixtures):
Utility/Laundry/Sewing Room(s) (Over 150 Sq. Ft.):
Finished Basement (Omit if counted as a family/recreation room):
Attached two car garage:
Finished Attic:
Yes
No
Partly finished attic (count as 1/2 if not 150 sq. ft.):
Yes
No
Partially Finished Basement:
Yes
No
Brick/Stone Exterior Walls:
Yes
No
Central A/C:
Yes
No
Aluminum/Vinyl Siding:
Yes
No
Large Wall Fireplace:
Enclosed Porch/Breezeway :
Clay Tile or Slate Roof:
Yes
No
Screened Enclosure (Florida Room):
Please list any other units not listed above:
Construction 1/2 Unit Information
Please insert numbers in the boxes below
Half Bath :
Large Open Porch/Breezeway:
Standard Fireplace :
Unfinished Basement (With or without a built-in garage)
Attached One-car Garage:
Built-in Two-car garage:
Utility/Laundry/Sewing Room(s) (Under 150 Sq. Ft.):
Foyer/Entrance Hall
Dressing Room/Walk-in Closet
Unfinished Attic
Finished Attic (Less than 150 sq. ft.)
Mud Room (With separate entrance)
Brick/Stone/Veneer (Front Wall)
Dinette or Partitioned Breakfast Nook
Residence Information
Effective date of coverage:
Location of residence (if different from above):
Is this a Primary or Secondary residence?
Primary
Secondary
Approximate year of construction:
Construction type:
Frame
Masonry
Brick veneer
Fire resistive
Aluminum siding
Any losses in the last 3 years?
Yes
No
Number of families:
1
2
3
4
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:
Please select
None
Fenced In
Not Fenced In
Do you own a dog?
Yes
No
If yes, what breed?
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:
Yes
No
Golf Equipment:
Silverware:
Cameras:
Furs:
Musical Instruments:
Guns:
Comments or additional pertinent information:
Submitting an insurance quotation request to Durkin & DeVries Insurance does not constitute a binding confirmation of new or altered insurance coverage. Verbal or written confirmation must be obtained from Durkin & DeVries Insurance to confirm binding or altering coverage.
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