Business Name:    
Premises Address:
City:   Florida     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 
Description of Operations or SIC code:



Property Coverage Amount Desired:     $
Property Coverage Deductible Amount: $
Liability Coverage Amount Desired:  
Umbrella Coverage Amount Desired:
Year built:          
Number of units:


Building Value:     $
Contents Value:    $
Construction Type:
Sprinklers:      
Central Alarm:

Claims in the last 3 years:
Description of claims:



Current Insurance Company: 
Policy Expiration Date:          (mm/dd/yyyy)

Additional Information or Comments



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Information received from this south Florida condominium association insurance quote request
form sent to Insurance Benefit Agency will be for our use only and will not be sold, given to or
distributed to any other parties. A quote will be based on the condominium association insurance
information provided and does not guarantee acceptance of the risk by us. The precise coverage
afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions
of the policy as issued. By submitting this request you acknowledge that this is neither an offer
to insure nor a guarantee of insurance. Completion of this form does not entitle you to Florida
condominium association insurance.
We are licensed in Florida only and will not provide condo
association insurance quotes for other states.

"Your Florida Condominium Association insurance specialist!"
We offer cheaper Florida condominium association insurance policiy quotes in the
following south Florida counties and cities: Miami-Dade County, Broward County,
Palm Beach County, Coral Gables, Kendall, Richmond Heights, Pinecrest, Howard,
Coral Way Village, Westchester, Westwood Lakes, Brownsville, Sweetwater, Key
Biscayne, North Bay Village, Miami Beach, Miami Springs, Virginia Gardens,
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Pines, North Miami Beach, Hallandale Beach, Ives Estates, Pembroke Park,
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Springs, North Lauderdale, Lighthouse Point, Hillsboro Beach, Coconut Creek,
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Beach, Boca Pointe, Boynton Beach, Lantana, Rainbow Lakes, Atlantis, Lake
Worth, South Palm Beach, Palm Springs, Greenacres, Wellington, Haverhill, Palm
Beach, Golden Lakes, Riviera Beach, Glen Ridge, West Palm Beach, Lake Park, Royal
Palm Beach, Jupiter, Juno Beach, North Palm Beach, Loxahatchee, Belle Glade, Palm
Beach Shores, South Miami, Cutler Ridge, Princeton, Perrine, Naranja, Homestead,
Florida City, and Leisure City, FL
Insurance Benefit Agency, Inc.
Florida Condominium Association Insurance
Miami, Florida
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"Your south Florida
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Florida Condominium
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Property Underwriters of Florida
Insurance Benefit Agency, Inc.
409 W. Hallandale Beach Blvd.
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Hallandale, Florida 33009
(305) 931-5988
(954) 454-9599
Toll Free: (866) 454-9555
Fax: (954) 843-0313
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