Niagara Montauk Insurance
  
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Niagara Montauk Insurance
1816 Liberty Building
Buffalo, New York 14202
1-800-775-2514
Fax: 1-888-271-1232

Timothy O. Overdorf
tover@niagaramontauk.com

In affiliation with:
Detailed Quote
By filling out this form, in conjunction with your 5 year loss history report, I will be able to provide you with a detailed, accurate firm quote. I will also compute a current replacement cost on your property at today’s construction rates. I may have a few more question depending on which state you are located in, but in most cases this form will answer all of the questions I will have.
Hotel Name (Franchise):
Legal or Corporate Name:
Address:
Contact Name & Title:
Phone Number:
Fax Number:
E-mail:
Date Your Current Policy Expires:
Current Building Limit:
Current Contents Limit:
Current Business Income & Extra Expense Limit:
Square Footage of Building:
Percent of the Building that is Sprinklered:

Construction of Building:
Responding Fire Department Name:
Distance From Fire House:


Distance from Fire Hydrant:
Desired Deductible:
Number of Rooms:
Number of Stories:
Number of Elevators:
Number of Indoor swimming pools:
Number of Outdoor swimming pools:
Approximate Annual Room Revenues:
Is there a restaurant on premises?
If there is a restaurant, is it leased out?
If it is, what is the restaurant square footage?
If it is leased out ,please skip the next two questions.
Approximate annual restaurant food/soft drink sales?
Approximate annual liquor sales?
What limit would you like for your Commercial Umbrella policy?
Commercial Auto (if any)

I will need a list of all drivers names, dates of birth & drivers license numbers
Vehicle 1:  
Year:
Make:
Model:
VIN #:
Vehicle use:
Garaging address:
If you would like physical damage coverage, what deductible would you like?
Cost of this vehicle new:
Current Value:

Vehicle 2:  
Year:
Make:
Model:
VIN #:
Vehicle use:
Garaging address:
If you would like physical damage coverage, what deductible would you like?
Cost of this vehicle new:
Current Value:

Vehicle 3:  
Year:
Make:
Model:
VIN #:
Vehicle use:
Garaging address:
If you would like physical damage coverage, what deductible would you like?
Cost of this vehicle new:
Current Value:

Vehicle 4:  
Year:
Make:
Model:
VIN #:
Vehicle use:
Garaging address:
If you would like physical damage coverage, what deductible would you like?
Cost of this vehicle new:
Current Value:

Vehicle 5:  
Year:
Make:
Model:
VIN #:
Vehicle use:
Garaging address:
If you would like physical damage coverage, what deductible would you like?
Cost of this vehicle new:
Current Value: