Sewer Back Up Questionnaire

Broker Information:

Limits: as indicated on quotation.
Note: This coverage is not available for dwellings without a back water valve:
Are there any plumbing fixtures below street level?:
Is the sewer line equipped with a back water valve?:
If septic tank, is it cleaned out annually?:

Are you aware of any previous difficulties/damage caused by sewer back up in the neighborhood?:
I agree that by submitting this application, I am electronically signing the application. Please note: policy not bound until you receive confirmation: