APARTMENT BUILDING WORKSHEET

 

First Name:

Last Name:

Mailing Address:

Mailing City:

Mailing State:

Mailing Zip Code:

Phone Number:

Fax Number:

E-Mail Address:

PROPERTY INFORMATION

 

Property Address:

 

Property City:

Property State:

California

Property Zip Code:

How Many Units In The Building?

How Many Units In The Building Are Vacant?

Year Built:

Date You Purchased The Property:

Construction Type:

 

How Many Stories:

If Two Stories, Ground Floor Square Footage:  

Total Square Footage of The Building:  

Is There A Basement?

yes no 

Garage Description:

 

Roof Type:

 

Roof Updated:

yes no 

If Yes, Year Roof was Updated:

Does The Dwelling Have A Pool?

yes no 

If Pool, Is It Fenced?

yes no 

If Pool, Is There A Diving Board?

yes no 

If Pool, Is There A Slide?

yes no 

Protection Distance:

Is The Building in the Brush?

yes no 

Is there a Brush Hazard within (1) mile of The Building?

yes no 

If yes, has the Brush been cleared by 250 feet from all sides of The Building?

yes no 

Smoke Alarm:

yesno

Fire Extinguisher:

yesno 

Deadbolts:

yesno

Electrical Updated:

Circuit Breakers:

yes no

Does The Electrical Circuit Box Have Copper Wiring?

yes no

Heating - Air Conditioning, How Old?:

Heating - Air Conditioning, Thermostatically Controlled?:

yesno 

Energy Source: 

Heating - Air Conditioning, Central?

yes no 

Has The Plumbing Been Updated?

yes no

If Yes, Year Plumbing was Updated:

Copper Plumbing:

yes no 

Does the Building Have Interior Automatic Fire Sprinklers? 

Theft Alarm:

Fire Alarm:

Earthquake Zone:

Earthquake Retrofitted: 

 

Fire District:

Current Insurance Company:

Any Dogs on the Property:

yes no

If Yes, Number & the Breed of Each Dog:

 

Any Other Pets-Animals on the Property:

yes no 

If Yes, Number & Description of Each Pet-Animal:

Losses-Claims in the last 5 years: 

 

If Yes, Date, Amount Paid & Description of Each Loss-Claim

 

 

COVERAGE INFORMATION

 

Dwelling Amount (Coverage A):

 

Other Structures (Coverage B):

Business Property (Coverage C):

Loss of Use (Coverage D):

Premise Liability (Coverage E):

Policy Deductible:

If Earthquake Insurance is Requested, Select Deductible Percentage %:

 

Building Replacement Cost Coverage: 

yesno 

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Then wait for online confirmation of your request.
Thank you for your interest.