ROCKHILL INSURANCE GROUP

APARTMENTS GENERAL LIABILITY

SUPPLEMENTAL QUESTIONNAIRE

  1. Name Insured: ______DBA:______
  2. Interest: Owner Property Manager ______# of years owned/managed at this location

______# of years experience

  1. Location Address: ______
  2. Website: ______
  3. Community type: Cooperative Apartment Timeshare Apartment

General Apartment Information

  1. Number of buildings: ______Age of buildings: ______Number of stories: ______

Number of units: ______Percentage occupied: ______

  1. Construction of buildings: ______
  2. Construction last updated: Roof: ______Electrical: ______Plumbing: ______Heating: ______

If over 10 years, please provide details: ______

If aluminum wiring, have all outlets been updated (CO/ALR) and checked by a licensed electrical contractor within the past 5 years? ...... Yes No

  1. Management on site: Yes No Maintenance on site: Yes No Hours of availability: ______
  2. Is there an elevator on the premises?...... Yes No
  3. Condition of the property? Good Average Poor
  4. Surrounding area? Improving Stable Declining
  5. Please provide the percentages, if any, of the following occupancy types:

____% Student Housing ____% Subsidized ____% Elderly

Are there any pull cords, medical assistance, meals, or transportation available for tenants? Yes No

  1. Annual rental income: $______

Monthly: 1 bedroom $______2 bedroom $______3 bedroom $______

  1. Are parking areas paved? ...... Yes No

Condition of parking area? Good Average Poor

Restricted speed limits in parking areas? ...... Yes No

Speed bumps in parking areas? ...... Yes No

  1. Are tenants required to carry renters insurance? ……………………………………………………………..…….. Yes No

Fire/Safety Information

  1. Are space heaters utilized or are tenants permitted to have space heaters?...... Yes No
  2. Are hallways and/or stairwells open or closed? ______Number of exits? ______
  3. Fire doors and panic hardware? ...... Yes No
  4. Are alarms monitored by a central station? ...... Yes No
  5. Are heat/smoke detectors in each unit? ...... Yes No

Where are detectors located? Kitchen area Hallway leading to bedroom Bedroom

How often are detectors tested? ______

Are heat/smoke detectors: Hard Wired Battery

How often are batteries replaced? ______

  1. Are carbon monoxide detectors in each unit? ...... Yes No
  2. Is there emergency lighting? ...... Yes No
  3. Is risk sprinklered? ...... Yes No
  4. Is property compliant with all city/state housing codes? ...... Yes No

Swimming Pool Information Check here if not applicable

  1. Number of pools: ____
  2. Are lifeguards employed by you or subcontracted?

Yes, employed Yes, subcontracted No lifeguards

If subcontracted, are certificates of insurance provided? ...... Yes No

  1. Are pools fenced from all units...... Yes No

If yes, what is the height of the fence? ______

Self closing gate? ...... Yes No

  1. Is there a diving board or slide? ...... Yes No

If yes, what is the height of the board? ______

  1. Are there depth markers? ...... Yes No

Depth of pool: ______

  1. Life saving safety hook or ring nearby? ...... Yes No
  2. Are warning signs and rules posted in a clearly visible area? ...... Yes No
  3. Are buildings or other structures within 10 feet of edge of pool? ...... Yes No

Security

  1. Are sliding glass doors equipped with additional locks? ...... Yes No
  2. Do entry doors have peepholes? ...... Yes No
  3. Do entry doors have keyless deadbolts? ...... Yes No
  4. Are there any security guards on premises?...... Yes No

If yes, please provide details in regards to whether they are armed or unarmed, off-duty police, independent security firm or employees, and if there is any non-cash compensations: ______

  1. Are there fences and/or gates surrounding the property?...... Yes No

Is there an automatic access gate to the property?...... Yes No

  1. Are criminal checks done on employees?...... Yes No
  2. Are criminal checks done on prospective tenants?...... Yes No

Are credit checks done on prospective tenants?...... Yes No

  1. Have there been any previous incidents of physical or sexual assault?...... Yes No

If yes, please provide details: ______

  1. Crime and vandalism in neighborhood: High Medium Low
  2. Are tenants informed of crime and vandalism activity?...... Yes No
  3. Is there a regular tenant news bulletin provided by the applicant?...... Yes No
  4. Are locks changed for each new tenant?...... Yes No

Maintenance

  1. Are there written procedures for inspections of your premises?...... Yes No

If so, how often do you inspect? ______

  1. Do you keep written logs of all maintenance/repairs?...... Yes No
  2. Do you have written procedures for responding to tenant complaints?...... Yes No

Do you keep written logs of all complaints?...... Yes No

  1. Is maintenance, lawn care, or snow removal performed by employees or subcontractors?

Yes, employees Yes, subcontractors No

  1. If outside contractors, is a certificate of insurance provided?...... Yes No

Other

Confirm that lease/rental agreement makes no warranties with regard to security and that leasing agents/employees are instructed to advise potential and current tenants to dial 9-1-1 in the event of an emergency……………………………………………………………………………………………………………………………………… Yes No

Any of the following? Please describe all yes answers in detail below.
Baseball fields / Yes No / Exercise facility / Yes No / Sewage treatment plants / Yes No
Basketball courts / Yes No / Lakes / Yes No / Special events / Yes No
Bathing beaches / Yes No / Parks / Yes No / Streets/roads / Yes No
Bike/horse trails / Yes No / Playgrounds / Yes No / Tennis/volleyball courts / Yes No
Boat docks/slips / Yes No / Racquetball courts / Yes No / Waterworks / Yes No
Clubhouse / Yes No / Restaurants / Yes No
Convenience stores / Yes No / Saunas/spas / Yes No

Details: ______

Prior Policy Information

  1. Do you have any knowledge of incidents that could lead to a claim in the future?...... Yes No

If yes, please explain: ______

  1. Has your insurance been cancelled, declined or non-renewed in the last three years?...... Yes No

If yes, please explain: ______

The undersigned Applicant warrants that the above statements and particulars together with any attached or appended documents are true and complete and do not misrepresent, misstate or omit any material facts.

The Applicant agrees to notify us of any material changes in the answers to the questions on this questionnaire which may arise prior to the effective date of any policy issued pursuant to this questionnaire and the Applicant understands that any outstanding quotations may be modified or withdrawn based upon such changes at our sole discretion.

Notwithstanding any of the foregoing, the Applicant understands that we are not obligated or under any duty to issue a policy of insurance based upon this information. The Applicant further understands that, if a policy of insurance is issued, this questionnaire will be incorporated into and form a part of such policy.

Signature of Applicant: ______Date: ______

Title (Owner, Officer, Partner) ______

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