Hing & Associates Insurance Brokers Inc.   United Agencies Inc.  
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HOTEL/MOTEL INSURANCE QUOTE

We would like to provide you with a free, no-obligation hotel/motel insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.
General Information
Name of Business:
Contact Name:
Mailing Address:
City:    State:    Zip: 
Business Phone:   Fax:
Best Time To Call:  AM   PM
Contact Email Address:
Insured Is:     How Long in Business:

Property Information
Street Address:  
City:     State:   Zip:
Year Built:   # of Buildings:  
# of Units:   # of Stories:  
Total Building Square Footage:   sq. feet
Building Construction:   Type of
Parking: 		 
Type of Roof:   Year Roof
Last Updated: 		 
# of Pools:   Are pool(s)
Fenced: 		 
Are there diving
boards: 		  Is there a
pool slide: 		 
# of in-room Jacuzzis:   # of
Kitchenettes: 		 
Type of Electrical:   Year Electrical
Last Updated: 		 
Type of Heating:   Year Heating
Last Updated: 		 
Type of Plumbing:   Year Plumbing
Last Updated: 		 
Automatic Fire
Sprinklers: 		  On All Floors:  
Fire Alarms:   Smoke
Detectors: 		 
Burglar Alarms:   On-Site
Security: 		 
Total Sq. Footage
of Restaurant: 		  sq. ft. Restaurant
Operated By: 		 
Liquor Receipts:   $ Bar Serves:  
Total Sq. Footage
of Retail Stores: 		  sq. ft. Total Sq. Footage 
of Banquet Halls: 		   sq. ft.
Total Sq. Footage
of Exterior Glass: 		  sq. ft. Distance to Lake,
River, Ocean: 		 
Hotel is owned by:   Is the hotel part
of a franchise: 		 

Desired Coverages
Building Amount:   $ Annual Income:   $
Contents Amount:   $ Deductible:  
Exterior Glass:   $ Accounts Receivable:  
Employee Dishonesty:   Employee Benefits Liability:  
Money & Securities:   Valuable Papers:  
Building Ordinance:   Yes   No Agreed Amount Endorsement:    Yes   No
Inflation Guard:   Outdoor Sign Value:  
Earthquake Sprinkler
Leakage: 		  Yes   No # of Additional Insureds:   
General Limit Liability:   Guest Medical:  
Liquor Liability:   Non-owned/Hired Auto Liability:  
Inn-Keepers Legal
Liability: 		  Tenant Fire Legal Liability:  
Garage Keepers
Collision Value: 		  Garage Keepers
Collision Deductible: 		 
Garage Keepers Other
Than Collision Value: 		  Garage Keepers Other
Than Collision Deductible: 		 

Current Insurance Information
Current Insurance Company:   Policy Expiration Date:  
# of claims in last 3 years:  
List all claims below in past 3 years:
Type of Claim:  
Date:   Amount Paid:   $
 
Type of Claim:  
Date:   Amount Paid:   $
 
Type of Claim:  
Date:   Amount Paid:   $
 
Type of Claim:  
Date:   Amount Paid:   $
 
Type of Claim:  
Date:   Amount Paid:   $

Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough space, please enter them here.


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