Special Event Insurance Application

Habitational Property Supplemental

Any periodic inspections of Stairs, Balconies, Walkways, etc.?*

Yes
No

How often?*

What percentage of your building is occupied?*

Please explain why occupancy is less than 90%.*

Do you have any of the following?*

Please provide the percentage of the building that has the above options.*

Who operates the Assisted Living facility?*

Owner
Third Party

Is management on site?*

Yes
No

Do employees perform maintenance at site?*

Yes
No

Do you allow tenants to have pets?*

Yes
No

Are any of the following services provided?

Who provides the above services?

Employees
Third Party

What type of wiring?*

Copper
Aluminum

Are all switches and receptacles fixed using the CopAlum Crimp method?*

Yes
No

Is the property within 2500 feet of a "brush area"?*

Yes
No

How many buildings are there?*

How many stories?*

What is the building square footage?*

Please check all of the following that the building has:

None
Interior stairways enclosed and equipped with self-closing fire doors on each floor
Pull type “Life Safety” alarm
Alarm on each floor
Live safety sprinkler system covering stairs and hallways
Trash shoots
Elevators

How many elevators?*

Which of the following has smoke detectors?

Are smoke detectors monitored on a 24-hour basis?*

No
Yes, by Employees
Yes, by Third Party

Is there emergency lighting in interior corridors longer than 75 feet?*

Yes
No

Are there lighted EXIT signs in interior corridors?*

Yes
No

How are the multiple buildings separated?*

Are there fireplaces in the units?*

No
Electric
Gas
Wood Burning

Automatic Earthquake Gas Shutoff Valve installed?*

Yes
No

Any swimming pools?*

Yes
No

Any spa(s)/Jacuzzi?*

Yes
No

Please check all of the following that apply:*

None
Pool/Spa is fenced
Fence complies with local ordinances
Self-Closing/Self-Latching Gate
Diving Boards
Pool/Spa rules clearly posted in the pool area
Lifesaving equipment (i.e. life ring, shephards hook) in pool/spa area
Safety Drain/Intake Covers

How tall is the fence?*

Please check all the following that apply:

What type of surface are your playgrounds?*

What equipment do you have on the playgrounds?*

How many Tennis/Basketball courts do you have?*

Are the golf courses for the exclusive use of the members?*

Yes
No

Income Property – Lessors Risk Insurance Application

Vesting/Registered Owner Information

Non-Habitational Information

Habitational Property Supplemental