All Weather Insurance Agency

Quote Request (Snow Insurance)

Contact Information **Please note that there is a $1,000 minimum premium amount applicable to all policies**

* Required Fields

Name:*

Company:*

Address:*


City:		State:		ZIP:

Phone:*

Fax:*

Email:*

Insurance Broker:

Yes \| No
If (Yes), Name of Agency:

Insured Date(s)/Period:

Previous Weather Insurance

a) Has this event been insured before? Yes \| No
b) If Yes, with which Insurance Carrier?:

Financial History
(only for seasonal snow removal coverage)

Current Annual Snow Removal Budget: $

Two (2) Year Snow Removal Expenses Realized:

Last Year:	$
Two Years Ago:	$

Coverage Options

a) Per INCH - # of Deductible Inches:

35"	40"	45"	50"	55"	60"
65"	70"	75"	80"	85"	Other

Amount Per Inch: $

b) Per STORM Storm Definitions:

3"	4"	5"	6"
8"	10"	12"	Other

Amount Per Storm: $

Claim Settlement:

Closest Hourly National Weather Station to the Event Location(s):

Independent Weather Observer on- or off-Location: