Email: dmathews@ma-insurance.com | Address: 840 Liberty Street, Springfield, Massachusetts 01104
 
 
 
 
Sullivan Keating & Moran Insurance Agency of Springfield Inc.
 
INSURANCE AGENCY OF SPRINGFIELD INC.
 
It's a good policy to know your agent!
 
 
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Online Quotes

Church Insurance Quote Form

 
 
1. Name Business:

 
 
 
Name Owner:
 
 
 
E-Mail Address:

 
 
 
2. Address / Zip:

 
 
 
3. Bus. Phone / Fax / Home:
 
 
 
Company Name (not agent):
 
 
 
Policy Number:
 
 
Expiration Date:
 
 
 
6. Please indicate if Church has any of the coverage in place or interested in obtaining more info:
 
 
 
 
 
7. Building Location #:
 
 
 
 
Description of Property:
 
 
 
 
 
8. Exterior Walls:
 
 
 
Roof:
 
 
 
 
Sprinkled:
 
 
Year Built:
 
 
 
Number of floors:
 
 
Basement:
 
 
 
Ground Floor Area (LxW):
 
 
Second Floor Area (LxW):
 
 
 
Basement Floor Area (LxW):
 
 
Total Square Ft:
 
 
9. Coverage: Property
 
Church Building $
 
 
Property $
 
 
 
LIABILITY:
 
 
Deductible
 
 
 
10. Central Heat?:
 
 
Heating & Cooling:
 
 
 
11. Name of Fire Dept.:
 
 
 
12. Miles from Fire Dept.:
 
 
13. In City limits?:
 
 
 
Distance from nearest Fire Hydrant (ft):
 
 
Fire/Burglar Alarm Devices:
 
 
 
12. Claims History last 5 years-Date of Loss:
 
 
13. Amount Paid & Description of occurance: