Tiny Home Insurance Application

*****Please note that this is just an indication and not your actual quote******

Questions or concerns? Contact Ashley@cig-llc.biz.

Need a schedule for a fleet of tiny homes? Ivy has one!

Page 1
Page 2
Page 3
Page 4

Name

Are you an agent? *

Name of Applicant *

Email Address *

Phone Number *

Business Phone

Mailing Address *

Mailing City *

Mailing State *

Mailing Zip Code *

Location of tiny home (when you buy insurance)

Same as Mailing Address

Physical Address *

Physical City *

Physical State *

Physical Zip Code *

Effective Date

Applicant Name

Occupation

Date of Birth

Marital Status

Co-Applicant Name

Co-Applicant Occupation

Co-Applicant Date of Birth

Co-Applicant Marital Status

Do you have an existing tiny home insurance policy? *

Name of Carrier

Any Prior Claims? *

Total in Claims

Tiny Builder

Trailer Builder

Additional Optional Information

Value of Home

$45000.00

Typically valued between $25,000 and $150,000. If more, please call us.

Purchase Price

$50000.00

Purchase Date

Serial Number

Other Structures

We can offer additional coverage for detached buildings, built on porches, and items such as solar panels.

Contents

Include all loose items in your tiny home. (pots, pans, clothing, bed, T.V., stereo, etc...

Theft of Contents

The policy normally does not cover theft of your personal belongings. We can add theft coverage up to $3,000 for a small charge.

Trip Endorsement

We can cover you when you move your tiny home.

Estimated Moves Per Year

If Trip Endorsement is selected.

Theft of Tiny Home

Interested in Financing?

Personal Liability

Liability covers slips/falls and getting sued.

Medical Payments

Each person

Please select your dwelling location:

Year Built

2017

Number of Rooms

Square Feet

400 sq. ft.

Length in Feet (Not Tongue)

26 ft.

Width in Feet

8 ft.

Height in Feet

13.5 ft.

Construction

Type of Roofing

Primary Heat Source

Wood Stove or Fireplace

Please select your usage type:

Does the applicant own, keep or shelter any animal with a previous bite history or any non-domestic animals?

Does the premises have a swimming pool or spa?

Has the applicant had a homeowners/dwelling policy cancelled or non-renewed for any reason?

Has the applicant filed for bankruptcy in the past 36 months?

Has the applicant been 30 days past due on mortgage payments in the last 12 months?

Is there any unrepaired or existing non-structural damage in the dwelling?

Is there a business operating from the tiny home?

Are there multiple horses, livestock or farm animals on the premises?

Is there a dock, pier or boat house on the premises?

Is the dwelling on 5 or more acres?

Are farming activities conducted on the premises?

Has the home been uninsured for more than 30 days immediately prior to the requested effective date?

Does not apply to a new purchase.

Does the dwelling have permanently installed steps and handrails, if 3 or more steps, on all entrances?

Is the dwelling located within 1,500 feet of a body of water?

Is the dwelling tied down when parked at its primary location?

Is there a mortgage?

About Your Home

Note: This information is completely optional and has no influence on your insurance. Commercial Insurance Group may use your tiny home information for statistical data or on a website.

Would you like to provide a few extra details about your home? *

Your Quote

The price shown below is an estimate only.

Estimated Total Premium

Estimated Taxes

Policy Fee

Service Fee

Estimated Total

Location of tiny home (when you buy insurance)

Additional Optional Information

About Your Home

Your Quote

Homeowners/Dwellings

Construction

Property

Hospitality

Professional

Personal Lines

Products

Liability & Excess

Specialty

Garage & Dealers

Auto & Trucking

Transportation