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Home » Our Forms » NTIS Insurance Questionnaire for Historic Properties

Every historic property is different. Consider filling out our form and we’ll get back to you soon.

Get the insurance coverage your historic property needs.

Please complete the form to your best ability. Fields marked with an * are required.

"*" indicates required fields

Step 1 of 6

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This field is for validation purposes and should be left unchanged.

Name*

First Name* Last Name*

Email*

Legal Name Of Ownership*

Name/Nickname of Building (If Applicable)*

Location Address

Street Address Address Line 2 City State/Prov./Region ZIP/Postal Country

What is the building primarily used for?*

Year Built*

Number Of Stories?*

Total Square Footage of Building*

Exterior Construction*

Combustible (i.e. Frame Construction, Wood Siding, or similar)

Non-Combustible (i.e. Brick, Concrete, Metal Siding, or similar)

Roof Type (i.e. metal, shingle, flat, other)*

Age of Roof (i.e. number of years old)*

Plumbing type*

Copper

PVC

Galvanized

Other

N/A (No Plumbing)

Year Plumbing last Inspected/Updated*

Describe Heating*

Gas

Oil

Heat Pump

Other

N/A (No Heat)

Year Heating last Inspected/Updated*

Active Electrical*

Circuit Breakers

Fuse Box

Aluminum Knob and Tube

Other

N/A (No Electrical)

Year Electrical last Inspected/Updated*

Does the building have an alarm system?*

Yes

If yes, is it centrally monitored?*

Yes

Does the building have a sprinkler system?*

Yes

Is the building on the local/state/national register of historic places?*

Yes

Have you had a Property or General Liability claim in the last 3 years?*

Yes

If yes, please explain.

Please do not include sensitive, private information in this area.

Other relevant information you’d like to share about the building

Please do not include sensitive, private information in this area.

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