WDBB INDICATION REQUEST

 

* indicates required fields 
  *Agent Name:
  *Email Address:
  *Phone #:
  *Location Address:
  *City:
  *State:
  *County:
  *ZIP:
  *Distance to tidal water:
  *Construction Class:
  *Year Constructed:
  *Age of roof:  0-4.99 Years Old
 5-9.99 Years Old
 10 + Years Old
  *Mitigation Modifiers:  Hip Roof
 Gable Roof
 Flat Roof
 SIngle Ply Membraine
 Shingle 55 MPH rated
 Shingle 110 MPH rated
 Tile Roof
 Metal roof
 Wood Shingle
 Built Up
  *Building Limit:
  *BPP Limit:
  *BI Limit:
  *Micellaneous property:
  *Total Insured Values:
  *Primary Deductible:
  *Does this apply to BI?:  YES
 NO
  *New deductible desired:
  *Is there a minimum "Per Occurance deductible?:
  *Does the Wind deductible apply to Business Income?:  YES
 NO
  *Please indicate the Primary Wind Clause:  Wind & Hail / TIV
 Wind & Hail / Per Building
 Hurricane Deductible
 Hurricane Calender Yr Ded.
  *Number of Buildings::
  *Referring Underwriter:  Ken Haupert
 Kathy D'Alesio
 Lashon Woodberry
 John Pedre
 John Farley
 John Traver
 Jeff Haupert
 No Underwriter assigned
  *Any wind Losses Prior 5 years? Pleaseexplain::

Please click on the Submit button to submit the form details.

If you would like to firm-up our indication please submit your risk on our application.
 

Sigma Underwriting ManagersSM. All rights reserved. Certain coverages may not be available in all states. Coverage will be written on a non-admitted basis only through licensed surplus lines brokers, The description here is a summary only, it does not include all terms, conditions and exclusions of the policies and coverages described.  PRIVACY STATEMENT
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