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Property Zip Code:
Owner Tenant Vacant Owner & Tenant
House Condo - Contents Townhome Apartment Building Office Building Condo Assoc Complex High Rise Building Manufacturing Building
How Many Stories:
1 2 3 4 5 6 7 8 9 10 More Than 10 Stories
Total Square Footage of the Building:
How Many Units Are In The Building:
No Carport - Garage Car Carport - Attached Car Carport - Detached Garage - Attached Garage - Detached Tuck Under Parking Above Ground Parking Below Ground Parking Parking Lot Street Parking
Frame Masonry Veneer Masonry Superior
Piers Wood Stilts Posts - Pilings Basement Masonry Rubble Stone Non-Reinforced Concrete Craw Space - Concrete Perimeter Craw Space - Wood Perimeter Flat Slab-Poured Reinforced Concrete
Nature of Sub-Soil:
Sand Clay Rock Marsh Filled Land Unconsolidated Ground Natural Consolidated Ground
Flat Cliff Terraced Steep Hill Gentle Hillside Under 100ft to Water Hillside Over 30 Degrees
Tile Slate Metal Woodshake Composite Material
If Yes, Year Roof Updated:
Any Erosion in the Area?
Any Below Ground Parking?
Any Soft First Story or Tuck Under Parking?
1000 ft or less to a hydrant & 5 mi or less to a fire station Over 1000 ft to a hydrant & 5 mi or less to a fire station Over 5 & up to 10 mi to a fire station Over 10 mi to a fire station
Is the Building in the Brush Area?
Is there a Brush Hazard within (1) mile of the Building?
If yes, has the Brush been cleared by 250 feet from all sides of
yes, recently updated no
Heating - Air Conditioning, How Old?
If Yes, Year Plumbing Updated:
None Partial full
Earthquake Retrofitted or Bolted:
Yes No, Building is Not Bolted Yes, Recently Bolted or Retrofitted for EQ
Current Insurance Company:
Losses-Claims in the last 5 years:
None One Two Three Four Five
If Yes, Date, Amount Paid and Description of each Loss-Claim
Other Structures Coverage:
Contents Property Coverage:
Loss of Use Coverage:
5% 7.5% >10% 15% 20% 25% 30%
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