Vikco Insurance Services, LLC

Vikco Commercial Earthquake Submission

Farmers Agent Information Farmers Producer Code:
Farmers Email Address:

(Must provide @farmersagent.com email address.)

Contact Name:
Phone Number:(xxx) xxx-xxxx

Insured Information Named Insured:
Mailing Address 1:
Mailing Address 2:
City:
State:
Zip Code:
Phone Number:(xxx) xxx-xxxx
Email Address:

Location Information Address 1:
City:
State:
Zip Code:
Construction Class: click here for description
Occupancy Type:
Year Built:
Number of Stories:
Total Square Feet:
Number of Buildings:
Parking: click here for description
Retrofit: click here for description

Please enter the total values for each of the following coverage types. Real Property includes the building value, and anything permanently attached to the building. Please click the for further details.

The Limit Requested cannot be greater than the sum of the values for the coverage types.

Real Property: click here for description
Contents: click here for description
Business Interruption:

Coverages Proposed Effective Date:mm/dd/yyyy
Limit Requested:
Perils:
Deductible Requested:
Optional Higher Deductible:

Policy History Current/Past EQ Carrier:
Policy Limit:
Deductible:
Premium:

Optional Coverages Building Ordinance: click here for description
Extended Period of Indemnity: click here for description

Notes