Applicant is a IndividualPartnershipCorporationLLCJoint Venture Requested Effective Date of Coverage:
Vacant Dwelling/Building/Mobile Home Location Information:
Coverage Limits
Building Information
Number of families or units:
Roof was replaced? (please provde year)
Construction: BrickFrameMasonary Non-Combustible (Brick with metal roof)All Metal (no frame construction)
Is there a pool, pond or lake on the property? Yes / No
General Questions
Mortgagee or Loss Payee Information
M c G R A T H I N S U R A N C E G R O U P 4170 William Penn Highway, Murrysville, PA. 15668-1890 (724) 327-8474 (fax) 327-7911 Toll Free: 1-800-977-2999 Fax: 1-888-800-0034