<% strMsg = "" Submit = "" Dim OwnersName, MailingAddress, Phone, Email, Fax, Website, FormOwnership, FormOwnershipOther, PropertyAddress, PropertyAddress2, Stories, Buildings Dim Units, SquareFootage, YearBuilt, RoofAge, RoofType, WiringUpdated, Fuses Dim PlumbingUpgraded, HeatingUpdated, HeatingType, SteamBoiler, RentalIncome, CommercialOccupancies Dim NotSprinklered, PartiallySprinklered, FullySprinklered, FireAlarm, FireAlarmCentralStation, FireAlarmLocal, BurglarAlarm, BurglarAlarmCentralStation, BurglarAlarmLocal, SmokeDetectors Dim FireExtinguishers, Construction, FoundationBolted, ResidentialOccupied, DogsAllowed Dim MoldKnowledge, StudentRenters, StudentUnitsOccupied, WindowBars '-- Read in all the form variables and assign their values to like-named local variables For Each F In Request.Form FormItemName = F FormItemValue = Request.Form(F).Item If FormItemValue <> "" Then FormItemValue = Replace(FormItemValue, """", """""") ' Kill any double quotes FormItemValue = Replace(FormItemValue, vbCrLf, """ & vbCrLf & """) 'Kill any carriage returns FormItemValue = """" & FormItemValue & """" Code = FormItemName & " = " & FormItemValue Execute(Code) End If Next If Submit = "Submit" Then If Trim(Len(OwnersName)) = 0 then strMsg = strMsg & "
  • Owner's Name
    • " end if If Trim(Len(MailingAddress)) = 0 then strMsg = strMsg & "
  • Mailing Address
    • " end if If Trim(Len(Phone)) = 0 then strMsg = strMsg & "
  • Phone
    • " end if If Trim(Len(Email)) < 5 then strMsg = strMsg & "
  • Email
    • " ElseIf Instr(1, Email, " ") <> 0 Then strMsg = strMsg & "
  • Email
    • " ElseIf InStr(1, Email, "@") < 2 Then strMsg = strMsg & "
  • Email
    • " ElseIf InStrRev(Email, ".") < InStr(1, Email, "@") + 2 Then strMsg = strMsg & "
  • Email
    • " end if If Trim(Len(Fax)) = 0 then strMsg = strMsg & "
  • Fax
    • " end if If Trim(Len(Website)) = 0 then strMsg = strMsg & "
  • Website
    • " end if If Trim(Len(FormOwnership)) = 0 AND Trim(Len(FormOwnershipOther)) = 0 then strMsg = strMsg & "
  • Specify Form Of Ownership
    • " end if If Trim(Len(PropertyAddress)) = 0 then strMsg = strMsg & "
  • Property Address
    • " end if If Trim(Len(PropertyAddress2)) = 0 then strMsg = strMsg & "
  • City, State, Zip Of Property Address
    • " end if If Trim(Len(Stories)) = 0 then strMsg = strMsg & "
  • # of Stories
    • " end if If Trim(Len(Buildings)) = 0 then strMsg = strMsg & "
  • # Of Buildings
    • " end if If Trim(Len(Units)) = 0 then strMsg = strMsg & "
  • # Of Residential Units
    • " end if If Trim(Len(SquareFootage)) = 0 then strMsg = strMsg & "
  • Square Footage
    • " end if If Trim(Len(YearBuilt)) = 0 then strMsg = strMsg & "
  • What Year was building built?
    • " end if If Trim(Len(RoofAge)) = 0 then strMsg = strMsg & "
  • What Year was last roof put on?
    • " end if If Trim(Len(RoofType)) = 0 then strMsg = strMsg & "
  • Describe type of roof
    • " end if If Trim(Len(WiringUpdated)) = 0 then strMsg = strMsg & "
  • What Year was wiring upgraded?
    • " end if If Trim(Len(Fuses)) = 0 then strMsg = strMsg & "
  • Any fuses in building?
    • " end if If Trim(Len(PlumbingUpgraded)) = 0 then strMsg = strMsg & "
  • What year was plumbing upgraded?
    • " end if If Trim(Len(HeatingUpdated)) = 0 then strMsg = strMsg & "
  • Year heating was updated?
    • " end if If Trim(Len(HeatingType)) = 0 then strMsg = strMsg & "
  • Type of heating?
    • " end if If Trim(Len(SteamBoiler)) = 0 then strMsg = strMsg & "
  • Do you have a steam boiler?
    • " end if If Trim(Len(RentalIncome)) = 0 then strMsg = strMsg & "
  • Annual Rental Income?
    • " end if If Trim(Len(CommercialOccupancies)) = 0 then strMsg = strMsg & "
  • Describe commercial occupancies:
    • " end if If Trim(Len(NotSprinklered)) = 0 then strMsg = strMsg & "
  • Not Sprinklered
    • " end if If Trim(Len(PartiallySprinklered)) = 0 then strMsg = strMsg & "
  • Partially Sprinklered
    • " end if If Trim(Len(FullySprinklered)) = 0 then strMsg = strMsg & "
  • Fully Sprinklered
    • " end if If Trim(Len(FireAlarm)) = 0 then strMsg = strMsg & "
  • Is there a fire alarm?
    • " end if If Trim(Len(FireAlarmCentralStation)) = 0 then strMsg = strMsg & "
  • Is there a fire alarm, central station?
    • " end if If Trim(Len(FireAlarmLocal)) = 0 then strMsg = strMsg & "
  • Is there a fire alarm, local?
    • " end if If Trim(Len(BurglarAlarm)) = 0 then strMsg = strMsg & "
  • Is there a burglar alarm?
    • " end if If Trim(Len(BurglarAlarmCentralStation)) = 0 then strMsg = strMsg & "
  • Is there a burglar alarm, central station?
    • " end if If Trim(Len(BurglarAlarmLocal)) = 0 then strMsg = strMsg & "
  • Is there a burglar alarm, local?
    • " end if If Trim(Len(SmokeDetectors)) = 0 then strMsg = strMsg & "
  • Are there smoke detectors?
    • " end if If Trim(Len(FireExtinguishers)) = 0 then strMsg = strMsg & "
  • Are there fire extinguishers?
    • " end if If Trim(Len(Construction)) = 0 then strMsg = strMsg & "
  • Specify construction type
    • " end if If Trim(Len(FoundationBolted)) = 0 then strMsg = strMsg & "
  • If frame construction, is building bolted to the foundation?
    • " end if If Trim(Len(ResidentialOccupied)) = 0 then strMsg = strMsg & "
  • What percentage of the residential units occupied
    • " end if If Trim(Len(DogsAllowed)) = 0 then strMsg = strMsg & "
  • Are dogs allowed?
    • " end if If Trim(Len(MoldKnowledge)) = 0 then strMsg = strMsg & "
  • Any knowledge of mold?
    • " end if If Trim(Len(StudentRenters)) = 0 then strMsg = strMsg & "
  • Are there any student renters?
    • " end if If Trim(Len(StudentUnitsOccupied)) = 0 then strMsg = strMsg & "
  • Units occupied by student renters?
    • " end if If Trim(Len(WindowBars)) = 0 then strMsg = strMsg & "
  • Are windows covered with bars?
    • " end if If strMsg = "" then '-- Send email strSubject = "Commercial Property Quick Quote Worksheet" strBody= now & vbNewLine & vbNewLine &_ "Name of Owners: " & OwnersName & vbNewLine & vbNewLine &_ "Mailing Address: " & MailingAddress & vbNewLine & vbNewLine &_ "Phone: " & Phone & vbNewLine & vbNewLine &_ "Email: " & Email & vbNewLine & vbNewLine &_ "Fax: " & Fax & vbNewLine & vbNewLine &_ "Website: " & Website & vbNewLine & vbNewLine &_ "Form of Ownership: " & FormOwnership & vbNewLine & vbNewLine &_ "If applicable, other Form of Ownership: " & FormOwnershipOther & vbNewLine & vbNewLine &_ "Property Address: " & PropertyAddress & vbNewLine & vbNewLine &_ "# of Stories: " & Stories & vbNewLine & vbNewLine &_ "# of Buildings: " & Buildings & vbNewLine & vbNewLine &_ "# of Residential Units: " & Units & vbNewLine & vbNewLine &_ "Square Footage: " & SquareFootage & vbNewLine & vbNewLine &_ "Year Built: " & YearBuilt & vbNewLine & vbNewLine &_ "Roof Age: " & RoofAge & vbNewLine & vbNewLine &_ "Roof Type: " & RoofType & vbNewLine & vbNewLine &_ "Wiring Updated: " & WiringUpdated & vbNewLine & vbNewLine &_ "Fuses: " & Fuses & vbNewLine & vbNewLine &_ "Plumbing Upgraded: " & PlumbingUpgraded & vbNewLine & vbNewLine &_ "Heating Updated: " & HeatingUpdated & vbNewLine & vbNewLine &_ "Heating Type: " & HeatingType & vbNewLine & vbNewLine &_ "Steam Boiler: " & SteamBoiler & vbNewLine & vbNewLine &_ "Rental Income: " & RentalIncome & vbNewLine & vbNewLine &_ "Commercial Occupancies: " & CommercialOccupancies & vbNewLine & vbNewLine &_ "Not Sprinklered: " & NotSprinklered & vbNewLine & vbNewLine &_ "Partially Sprinklered: " & PartiallySprinklered & vbNewLine & vbNewLine &_ "Fully Sprinklered: " & FullySprinklered & vbNewLine & vbNewLine &_ "Fire Alarm: " & FireAlarm & vbNewLine & vbNewLine &_ "Fire Alarm Central Station: " & FireAlarmCentralStation & vbNewLine & vbNewLine &_ "Fire Alarm Local: " & FireAlarmLocal & vbNewLine & vbNewLine &_ "Burglar Alarm: " & BurglarAlarm & vbNewLine & vbNewLine &_ "Burglar Alarm Central Station: " & BurglarAlarmCentralStation & vbNewLine & vbNewLine &_ "Burglar Alarm Local: " & BurglarAlarmLocal & vbNewLine & vbNewLine &_ "Smoke Detectors: " & SmokeDetectors & vbNewLine & vbNewLine &_ "Fire Extinguishers: " & FireExtinguishers & vbNewLine & vbNewLine &_ "Construction: " & Construction & vbNewLine & vbNewLine &_ "Foundation Bolted: " & FoundationBolted & vbNewLine & vbNewLine &_ "Residential Occupied: " & ResidentialOccupied & vbNewLine & vbNewLine &_ "Dogs Allowed: " & DogsAllowed & vbNewLine & vbNewLine &_ "Mold Knowledge: " & MoldKnowledge & vbNewLine & vbNewLine &_ "Student Renters: " & StudentRenters & vbNewLine & vbNewLine &_ "Student Units Occupied: " & StudentUnitsOccupied & vbNewLine & vbNewLine &_ "Window Bars: " & WindowBars SendEmail SendEmailTo, strSubject, strBody Response.Redirect "/realestate/thanks.asp" Else strMsg = "

    The form will not submit unless the following fields are completed:

    " End if End if %> Commercial Property Quick Quote Worksheet - Farallone Pacific Insurance Services

    Commercial Property Quick Quote Worksheet

    This form does not SAVE. If you cannot finish entering information onto this form in one setting, print the form out and fax it to the person in our office you are working with at 415-493-2505.

    <%= strMsg %>

    Name of owners:

    Mailing Address:

    Phone#:

    E Mail Address:

    Fax #:

    Web Site Address:

    Form of Ownership: (check one)
    >Corporation
    >LLC
    >Sole proprietor
    >Nonprofit
    >Partnership
    Other:

    Address of Property:

    City, State and Zip of Property Address:

    # of Stories:

    # of Buildings:

    # of Residential Units:

    Square Footage (exclude basements or unfinished areas):

    What Year was building built:

    What Year was last roof put on?

    Describe type of roof:

    What Year was wiring upgraded?

    Any fuses in building?
    >Yes
    >No

    What year was plumbing upgraded?

    Year heating was updated?

    Type of heating?

    Do you have a steam boiler?
    >Yes
    >No

    Annual Rental Income?

    Describe commercial occupancies:

    Is building sprinklered?

    Not Sprinklered
    >Yes
    >No

    Partially Sprinklered
    >Yes
    >No

    Fully Sprinklered
    >Yes
    >No

    Is there a fire alarm?
    >Yes
    >No

    Type of fire alarm:

    Central station
    >Yes
    >No

    Local
    >Yes
    >No

    Is there a burglar alarm?
    >Yes
    >No

    Type of burglar alarm:

    Central station
    >Yes
    >No

    Local
    >Yes
    >No

    Are there smoke detectors?
    >Yes
    >No

    Are there fire extinguishers?
    >Yes
    >No

    Construction Type (check one):
    >Wood Frame: wood frame walls/floors/roofs
    >Joisted Masonry: concrete/masonry/brick walls & frame roof and/or floors
    >Masonry Noncombustible: walls & roof are made from noncombustible materials and supported by non fire proofed structural steel frame
    >Modified Fire Resistive: buildings are structural steel frame that is fireproofed with masonry, concrete, plaster, gypsum or other noncombustible material. The walls are combustible materials, and floors are roofs are reinforced concrete or concrete on fireproofed steel deck.
    >Fire Resistive: Buildings with reinforced concrete frame. The walls are noncombustible materials, and floors are reinforced and roof is reinforced concrete on fireproofed steel deck.

    If frame construction, is building bolted to the foundation?
    >Yes
    >No

    What percentage of the residential units are currently occupied?

    Does the property owner and or management company allow tenants to have dogs on the property?
    >Yes
    >No

    Do you have any knowledge of any mold forming on any part of the interior or exterior of your buildings?
    >Yes
    >No

    Are there any student renters?
    >Yes
    >No

    If yes, # of units occupied by student renters:

    Are any windows covered with bars?
    >Yes
    >No

    Optional

    Please submit the following additional information via email or fax to 415-493-2505:

  • Other Helpful Information
  • Digital Photos
  • 3 years of loss history
  • Copy of current policy
  • Copies of Commercial Tenant leases
  • Summary of Insurance

    •