Insured: / Date:
Mailing Address:
Location Address:
PLEASE PROVIDE DETAILS FOR THE FOLLOWING ITEMS:
1. / Building condition, maintenance and updates:Overall condition of property:
excellent good average fair below average
Age of roof: Year of electrical system updates:
Property de-leaded? / Yes No
Flat roof / Year of plumbing system updates:
Pitched roof / Year of heating system updates:
Property built post 1965? / Yes No
Was building converted from another occupancy? / Yes No
If yes, describe:
If multiple/mixed occupancy, list other occupants:
For all buildings, are steps, walkways and parking lots free of any obvious defects? / Yes No
Are any of the following heat sources present in any of the units: Fireplaces (wood or coal burning), wood pellet stoves, coal stoves, gas on gas stoves or space heaters? / Yes No
Who is responsible for snow and ice removal?
If the Applicant is responsible for snow and ice removal, do they document who is responsible and when surfaces have been plowed, treated, etc? / Yes No
If a contractor is used for snow and ice removal, do they carry a minimum of $500,000 in liability, indemnify the Applicant in the snow removal contract and add the Applicant as as an Additional Insured on the contractors' policy? / Yes No
Are contractors used for yard maintenance/landscaping? / Yes No
If yes, does insured secure certificate of insurance for auto and general liability? / Yes No
Does insured have a contractual risk transfer program in place with contractors used to repair or maintain the insured’s property? / Yes No
Does the property contain any aluminum wiring? / Yes No
Does the property contain any knob and tube wiring? / Yes No
Are there any Stab Lok circuit panels or Stab Lok circuit breakers contained in the electrical system? / Yes No
2. / Total number of units: / Number of Floors:
Percentage Occupied: %
For Condominiums or Co-Ops, list number owner occupied:
For the following, if the answer is yes, list number of units / # Units
Any retirement, assisted living or senior units? / Yes No
Any vacant units? / Yes No
Describe tenant’s care for the property:
Are all tenants required to sign a lease of at least 6 months? / Yes No
3. / Are any neighboring buildings vacant or under renovation? / Yes No
Neighborhood is:
Favorable/Stable Moderate Crime/VMM Deteriorating
Comments:
4. / Is the building undergoing renovations or repairs at this time? / Yes No
If yes, describe:
5. / Is all equipment inspected annually and well maintained? / Yes No
Do smoke detectors work and meet local codes? / Yes No
With written battery replacement program? (ten year lithium battery with tamper-proof smoke detectors recommended)
If no, is insured willing to upgrade to 10 year lithium batteries? / Yes No
Yes No
Is there emergency lighting or signage? (required 4 stories or more) / Yes No
Are window guards provided? (if required by code: i.e., NYC) / Yes No
Are there hardwired smoke detectors within units? / Yes No
Are there hardwired smoke detectors in common areas? / Yes No
Is building sprinklered? (if yes, include percentage: %) / Yes No
Are barbecue grills allowed on decks, porches or balconies? (We require 15 ft. clearance from building.) / Yes No
Are carbon monoxide detectors working? (if required by code) / Yes No
If no, please explain:
Is there a secondary means of egress? / Yes No
Describe secondary means of egress:
6. / Liability Exposures:
Does insured own any other property or conduct any operations under this name? / Yes No
If yes, describe:
Has insured ever acted as a general contractor or sub contractor under this name? / Yes No
Are there any of the following on the premises:
Trampolines? / Yes No
Playground equipment? / Yes No
Swimming pools? / Yes No
Barbecue grills? / Yes No
Dogs? / Yes No
Are tenants allowed to keep vicious dog breeds on premises? / Yes No
7. / Is the building presently for sale? / Yes No
8. / Annual rents: $ or Condo fees (if applicable): $
9. / Year purchased: Purchase price: $
ADDITIONAL COMMENTS:
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