Apartment Liability Supplemental Application

Transcription

1 9200 E. Pima Center Parkway, Ste 350 Scottsdale, AZ Fax (480) Apartment Liability Supplemental Application (To be completed in addition to the ACORD Application) Applicant s Name: DESCRIPTION OF LOCATIONS Years owned Type of occupancy* Year built Number of Stories Number of Units total Number of Buildings Total square feet Pool? see section C. Manager on premises? If occupancy is mixed, please describe the nonhabitational occupancy. Square feet Percent of units subsidized Percent of university or college students as tenants *Use alpha code listed for type of occupancy: % % % % % % % % % % % % A Apartment Building B Garden apartments C Apartment hotel/timeshare WHI SUP-030 (10-10) Page 1 of 5

2 DESCRIPTION OF LOCATIONS (continued) If student housing, is this strictly graduate or family housing? Minimum lease term? How many times have the authorities been called? Subcontracted work Anticipated cost next twelve (12) months Certificates for subcontractors on file? *Use alpha code listed for type of occupancy: $ $ $ $ $ $ A Apartment Building B Garden apartments C Apartment hotel/timeshare 1. Are any of the properties residential senior, or retirement centers or assisted living centers?... Yes No a. If yes, what is the percentage of non-ambulatory above the fifth (5 th ) floor?... % b. If yes, do units have a pull chord or emergency notification systems?... Yes No c. If yes, do you have posted emergency evacuation plans?... Yes No 2. Are any of the properties housing authorities or do they include subsidized housing?... Yes No If yes, explain: 3. Are any locations currently or planned to be under renovation?... Yes No a. If yes, please describe the renovation: b. Do renovations include conversions to condominiums or townhouses?... Yes No RENOVATION/MOST RECENT UPDATE* Year and Type of Update Sidewalks and parking Patio balconies, railings, and stairways * Update information for electrical, plumbing, heating and roofing must be completed on the Acord. SWIMMING POOL(S) Number of pools Pool depth Diving board / platform height Slide height WHI SUP-030 (10-10) Page 2 of 5

3 SWIMMING POOL(S) (continued) Fully fenced with self latching gate? Compliance with Virginia Graeme- Baker pool and spa safety act? 1. Are the depth markings clearly shown?... Yes No 2. Are warning signs and rules posted and clearly visible?... Yes No 3. Is rescue equipment, including a ring buoy and twelve (12) foot pole or shepherd's hook, available poolside?... Yes No 4. Is pool maintained by applicant or outside contractor?... Applicant Outside Contractor If outside contractor, are certificates of insurance on file?... Yes No 5. Are lifeguards provided by:... Applicant Pool Management Company If provided by pool management company are certificates of insurance on file?... Yes No MAINTENANCE 1. Are sidewalks salted for snow or ice conditions?... Yes No Not applicable 2 How quickly is snow removed? 3. Who is responsible for upkeep of sidewalks and driveways? If subcontracted, are subcontractor certificates kept on file with AI status and limits equal to or greater than those proposed?... Yes No FIRE PROTECTION 1. Sprinklered?... Yes No All units?... Yes No Common areas only?... Yes No 2. Smoke detectors in each unit?... Yes No If yes: Hard-wire or battery? How often checked? 3. Carbon Monoxide detectors in each unit?... Yes No If yes: Hard-wire or battery? How often checked? 4. Fire extinguishers?... Yes No In common areas?... Yes No In each unit?... Yes No SECURITY 1. Is security provided?... Yes No If yes, what type? Patrol Gated access Alarm systems in each unit Security cameras 2. If patrol, please answer the following questions: a. Armed or unarmed? WHI SUP-030 (10-10) Page 3 of 5

4 b. Are the guards employees of the management or independent contractors?... Management Independent contractors If independent contractors, are certificates of insurance required?... Yes No Is the applicant named as additional insured on their policy?... Yes No c. Is the security twenty four (24) hours?... Yes No 3. Do the residents' doors or windows contain any of the following? Viewing windows in front doors Window locks/bars Lock pins for windows and sliding glass doors Dead bolts 4. Do any windows have burglar bars?... Yes No If yes, do the burglar bars have interior emergency quick releases?... Yes No If no, please list locations that do not have the emergency release: OTHER RECREATIONAL EXPOSURES Number of: Baseball field(s) Basketball court(s) Beaches Bike trails (miles) Boat slip(s) Clubhouse (sq. ft.) Lakes/Ponds (acres) Parks (acres) Playground(s) Racquetball court(s) Saunas Shooting Ranges Spa/Hot tub(s) Stables Streets/Roads (miles) Tennis court(s) Volleyball court(s) 1. Other: 2. Are these available to nonresidents for a fee?... Yes No If yes, annual receipts:... $ WHI SUP-030 (10-10) Page 4 of 5

5 This application does not bind the applicant nor the Company to complete the insurance, but it is agreed that the information contained herein shall be the basis of the contract should a policy be issued. APPLICANT S NAME AND TITLE: APPLICANT S SIGNATURE: DATE: (Must be signed by an active owner, partner or executive officer) PRODUCER S NAME: AGENT S NAME: LICENSED NO.: (Applicable to Florida s Agent s Only) NAME AND PHONE NUMBER OF INDIVIDUAL TO CONTACT FOR INSPECTION/AUDIT: IMPORTANT NOTICE As part of our underwriting procedure, a routine inquiry may be made to obtain applicable information concerning character, general reputation, personal characteristics and mode of living. Upon written request, additional information as to the nature and scope of the report, if one is made, will be provided. ANSWER ALL QUESTIONS IF THEY DO NOT APPLY, INDICATE NOT APPLICABLE WHI SUP-030 (10-10) Page 5 of 5