Potwora Agency West provides our family with friendly fast customer service.
I will be using them for years to come.
Linda B
Located with in the City of Buffalo? Yes No
If not recently purchased - Is the property currently for sale or been for sale in the past year? No Yes
Are there any businesses on the premises? No Yes
Type:
Distance from nearest fire department (mi)
Distance from nearest fire hydrant? (Ft)
Are there fire extingushers in each appartment? Yes No
Do any of your residents smoke? No Yes
Alternative Heating Sources: Check all that apply to the dwelling: Wood Stove Space Heaters Kerosene Heater Wood Burning Fire Place Wood Burning Fire Place with Gas Ignition Fire Place Insert
Check any of the following that apply to Dwelling Battery Operated Smoke Detectors Battery Operated Carbon Monoxide Detectors Hardwired Smoke Detectors Hardwired Carbon Monoxide Detectors Central Station Burglar Alarm Central Station Fire Alarm Sprinkler system
Flooring Percentages?
* ANY LOSSES WITHIN THE PAST 5 YEARS? No Yes
If YES please list
Purchase Price $
Current Market Value
Current Premium
Deductible
Liability
Loss of Use
Medical Payments
Are you looking for Replacement Cost Market Value Both
Would you like Sewer SL Water Backup? Yes No NOT SURE- PLEASE EXPLAIN WHEN YOU CALL WITH QUOTES
Replacement Cost on your contents? Yes No NOT SURE- PLEASE EXPLAIN WHEN YOU CALL WITH QUOTES
Coverage Basic Coverage Broad Coverage NOT SURE -PLEASE EXPLAIN WHEN YOU CALL WITH QUOTES
