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ASSOCIATION INSURANCE FORM

To be completed by Insurance agent only.

ASSOCIATION INSURANCE FORM

Agent: Please complete the following form using the current Association’s Insurance information

Name of Association (CONDO, HOA) *

Insurance Agent

Name *

Email Address *

Phone *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Insurance Period

Select the Coverage period *

TYPE OF INSURANCE: Hazard

CARRIER NAME *

POLICY NUMBER *

CARRIER PHONE NUMBER *

CARRIER ADDRESS *

COVERAGE STARTING DATE *

COVERAGE ENDING DATE *

TYPE OF INSURANCE: Liability

CARRIER NAME *

POLICY NUMBER *

CARRIER PHONE NUMBER *

CARRIER ADDRESS *

COVERAGE STARTING DATE *

COVERAGE ENDING DATE *

TYPE OF INSURANCE: Fidelity

CARRIER NAME *

POLICY NUMBER *

CARRIER PHONE NUMBER *

CARRIER ADDRESS *

COVERAGE STARTING DATE *

COVERAGE ENDING DATE *

TYPE OF INSURANCE: Flood

Does the Association have Flood Insurance? *

CARRIER NAME *

POLICY NUMBER *

CARRIER PHONE NUMBER *

CARRIER ADDRESS *

COVERAGE STARTING DATE *

COVERAGE ENDING DATE *

Are the units or common elements located in floor zone? *

If YES, flood coverage is in force equaling (Select only one option below)

Enter Flood Coverage Amount

ADDITIONAL INSURANCES

Is there any additional insurances no mentioned above? *

Additional insurance 1

CARRIER NAME *

POLICY NUMBER *

Additional insurance 2

CARRIER NAME

POLICY NUMBER

Additional insurance 3

CARRIER NAME

POLICY NUMBER

Please add any additional insurance is any:

CONTACT & HOURS

CONTACT –

Phone: 866-205-2250
Fax: 888-436-0522
info@realonepm.com

HOURS –

Monday to Friday:
9:00 AM to 12:00 PM
1:30 PM to 4:00 PM
Saturday, Sunday & US Holidays:
Closed

ADDRESS

MAILING ADDRESS:
Real One Property Management
PO Box 590035
Fort Lauderdale, FL 33359

OFFICE LOCATION:

Broward County –
4699 N State Road 7, SUITE D
Tamarac, FL 33319

Palm Beach County –
2393 S Congress Ave
West Palm Beach, Florida 33406

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