Collectible Items Quote - Graham-Rogers

Collectible Items

Agency Information

Agency Name *

Agency Code *

Agent's Email *

Agent First Name *

Agent Last Name *

Phone *

Applicant Information & Property Information

Requested Effective Date: *

Is this under a business name? *

Yes

Business Name *

Insured - First Name *

Insured - Last Name *

Applicant's Email *

Applicant's Phone Number: *

Applicant's Address: *

Country

City

State

Zip code

Mailing address same? *

Yes

Mailing Address: *

Country

City

State

Zip code

Collection Type: *

Description of item(s): *

Value of item(s): *

Safe Guards: *

Alarm or Safe

Bank

Two Safe Guards

None

Add another item? *

Yes

Collection Type? *

Description of item(s)? *

Value of item(s)? *

Safe Guards? *

Alarm or Safe

Bank

Two Safe Guards

None

Add another item *

Yes

Collection Type *

Description of item(s) *

Value of item(s) *

Safe Guards *

Alarm or Safe

Bank

Two Safe Guards

None

Construction Type: *

Frame

Masonry

Steel

Other - Specify

Year Built *

Building Security?

Central Station Alarm

Smoke Alarm(s)

Deadbolts

Bars

Has any company refused, cancelled, or non-renewed insurance on your collectibles? *

Yes

Have you filed a homeowner and/or collection claim in the last 5 years? *

Yes

Date of claim(s) *

Amount of Loss(es) *

In the event of a loss, are you able to provide documentation of your collectible(s)? *

Yes

How would you prove a loss? *

Note: Acceptable documentation of your collection includes records of your purchase, pictures or video of your inventory or a detailed inventory list.

Has the applicant had prior coverage? *

Yes

Prior Carrier: *

Policy number: *

Prior year premium: *

Was the collection impacted? *

Yes

Claim amount: *

Status of the claim: *

Open

Closed

Has all damages been repaired? *

Yes

Agreed Value Coverage for specified items? *

Yes

Provide a detailed description of the item(s) and agreed value of the item(s): *

Any Gold or Platinum coins? *

Yes

Gold and Platinum coins sublimit: *

Select all that should apply:

Water Exclusion

Bank or Safe Depository Limitation

Wind Exclusion

Full Coverage Burglary & Trust? *

Yes

How is this collection stored/displayed on the premises? *

Does this collection contain any of the following? *

An individual item or series/set is worth $25,000 or more (do not include items listed under Agreed Value coverage)

Some/all collectibles stored in a basement or other areas below ground floor

Some/all collection is stored in an immobile safe weighing at least 300lbs empty

Some/all collection is stored in a vault with 3-inch walls, no windows and a metal door

List all items or series/set is worth $25,000 or more (do not include items listed under Agreed Value coverage) *

Please add detailed description of each item and estimated replacement cost value of each item

Type of Lock on Safe: *

Combination

Digital

Key

Who has access to safe/vault? *

You

Immediate Family

Others

Construction of Vault: *

Add lender? *

Yes

Coverage Amount Limit? *

Is the lender the payee? *

Yes

Lender Address: *

Apt, suite, etc.

Country

City

State

Zip code

Please provide the percentage for Advertising Collectibles: *

Please provide the percentage for Antiques: *

Please provide the percentage for Antique Radios/Phonographs: *

Please provide the percentage for Antique Tools: *

Please provide the percentage for Art (comic, animation, prints, lithographs): *

Please provide the percentage for Bears/Steiff Collections: *

Please provide the percentage for Books & Manuscripts: *

Please provide the percentage for Club/Organization Memorabilia: *

Please provide the percentage for Coin Operated Devices: *

Please provide the percentage for Coins (Except Gold/Platinum): *

Please provide the percentage for Comics: *

Please provide the percentage for Dolls: *

Please provide the percentage for Entertainment Memorabilia: *

Please provide the percentage for Fine Art: *

Please provide the percentage for Furniture: *

Please provide the percentage for Glass/Pottery: *

Please provide the percentage for Hunting/Fishing: *

Please provide the percentage for Limited Edition Items: *

Please provide the percentage for Militaria: *

Please provide the percentage for Movie Props: *

Please provide the percentage for Musical Instruments: *

Please provide the percentage for Native American, Including Arrowheads: *

Please provide the percentage for Paper/Ephemera: *

Please provide the percentage for Petroliana: *

Please provide the percentage for Political Memorabilia: *

Please provide the percentage for Records & CDs: *

Please provide the percentage for Sports Cards & Memorabilia: *

Please provide the percentage for Toys/Action Figures: *

Please provide the percentage for Trading Cards: *

Please provide the percentage for Trains, Incl. Layouts: *

Please provide the percentage for Vintage Clothing: *

Please provide the percentage for Vintage Sewing & Textiles: *

Please provide the percentage for Western Americana: *

Please provide the percentage for Writing Instruments: *

Please provide the percentage for Zippo Lighters: *

Please provide the percentage for Other: *

Please provide any supporting documentation you may have

Document 2

Document 3

Document 4

Any additional Questions or Comments?

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