Building & Property Information |
| What is the property address? |
Property Street |
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| Property City |
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| Property State |
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| Property Zip |
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| What is the occupancy type? |
Occupancy Type |
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| What is the building type? |
Building Type |
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| What year was it built? |
Year Built |
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| What is the flood map zone number? |
Flood Map Zone Number |
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| What is the community flood number? |
Community Flood Number |
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| How many Bedrooms? |
Number of Bedrooms |
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| How many bathrooms? |
Number of Bathrooms |
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| How many fireplaces? |
Number of Fireplaces |
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| What date was it purchased? |
Date Purchased |
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| Does the residence have a basement? |
Basement |
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| What is the total square footage of the building? |
Total Square Footage of Building
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| How many units are in the building? |
Units |
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| What is the garage description? |
Garage Description |
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| How many stories is it? |
Stories |
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| What is the construction type? |
Construction Type |
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| What is the foundation type? |
Foundation Type
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| What is the nature of sub-soil? |
Nature of Sub-Soil
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| What is the topography? |
Topography? |
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| What type roof covering? |
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| Is the roof updated? |
Roof Updated |
Yes
No |
| If yes, what year? |
Year Roof Updated |
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| Is there any erosion in the area? |
Erosion |
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| Is there any below ground parking? |
Below Ground Parking |
Yes
No |
| Is there any soft first story or tuck under parking?
|
Soft First Story or Tuck Under Parking |
Yes
No |
|
What is the distance of fire protection?
|
| Is the business in a brush area? |
Brush |
Yes
No |
| If yes, has the brush been cleared by 250 feet
from all around the building? |
Brush Cleared by 250 Feet |
Yes
No |
| Are there smoke detectors at this location? |
Smoke Detectors |
Yes
No |
| Are there fire extinguishers? |
Fire Extinguishers |
Yes
No |
| Are there circuit breakers? |
Circuit Breakers |
Yes
No |
| Is the electrical updated? |
Electrical Update |
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| How old is the heating/ air conditioning? |
Age of Heating/ Air Conditioning |
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| What is the energy source? |
Energy Source |
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| Has the plumbing been updated? |
Plumbing Updated |
Yes
No |
| If yes, what year was the plumbing updated? |
Year Plumbing Update |
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| Is the plumbing copper? |
Copper Plumbing |
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| Does the building have interior automatic fire
sprinklers? |
Automatic Fire Sprinklers |
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| Is there a fire alarm? |
Fire Alarm |
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| Has the building been retrofitted or bolted? |
Retrofitted or Bolted
|
Claims Information |
| Where there any losses or claims
in the last 5 years? |
Losses - Claims |
Yes
No |
| If yes, what is the date, amount
paid and description of each loss or claim? |
|
Coverage Information |
| What is the current insurance
company? |
|
| How much are you paying now? |
Amount Current
Coverage |
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| What is the building coverage
requested? |
Building Coverage |
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| What is the other structures coverage
requested? |
Other Structures
Coverage |
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| What is the contents property
coverage requested? |
Contents Property
Coverage |
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| What is the loss of use coverage
requested? |
Loss of Use Coverage |
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| Are there any questions, comments
or additional coverage required? |
Questions, Comments
or Additional Coverage
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