Pacific Premier Insurance
Apartment Insurance Application
Owner or Purchaser Information
Please note: Missing information may cause a delay in processing
Full Name:
*
First Name
Last Name
Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address:
*
example@example.com
Business Entity Name:
*
Ex: ABC Holdings, LLC
Business Entity Type:
*
Please Select
Corporation
LLC
Individual
Trust
Partnership
Other
Effective Date (or Estimated Close Date):
*
-
Month
-
Day
Year
Mailing Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the mailing address the same as the property address?
*
Please Select
Yes
No
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Property Information
Please note: Missing information may cause a delay in processing
Property Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this a new purchase?
*
Please Select
Yes
No
How many years have you owned the building?
Current Insurance Provider (if any):
Total Building Square Footage:
Note: Square footage of ALL buildings
Year Built:
Number of Floors:
Estimated Annual Rent Income:
Current Occupancy Rate:
Note: Percentage of units currently occupied
Total Number of Units:
Total Number of Buildings:
Please Select
1
2
3
4
5
6
7
8
More than 8
Units and Square Footage per Building:
Rows
Bldg 1
Bldg 2
Number of units
Sq Footage of each building
Units and Square Footage per Building:
Rows
Bldg 1
Bldg 2
Bldg 3
Number of units
Sq Footage of each building
Units and Square Footage per Building:
Rows
Bldg 1
Bldg 2
Bldg 3
Bldg 4
Number of units
Sq Footage of each building
Units and Square Footage per Building:
Rows
Bldg 1
Bldg 2
Bldg 3
Bldg 4
Bldg 5
Number of units
Sq Footage of each building
Units and Square Footage per Building:
Rows
Bldg 1
Bldg 2
Bldg 3
Bldg 4
Bldg 5
Bldg 6
Number of units
Sq Footage of each building
Units and Square Footage per Building:
Rows
Bldg 1
Bldg 2
Bldg 3
Bldg 4
Bldg 5
Bldg 6
Bldg 7
Number of units
Sq Footage of each building
Units and Square Footage per Building:
Rows
Bldg 1
Bldg 2
Bldg 3
Bldg 4
Bldg 5
Bldg 6
Bldg 7
Bldg 8
Number of units
Sq Footage of each building
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Year of Last Updates (Plumbing):
Year of Last Updates (Electrical):
Year of Last Updates (HVAC/Heating):
Year of Last Updates (Roof):
Roof Type:
Please Select
Asphalt Shingle
Tile/Cement Shingle
Flat/Built up
Other
Building Condition:
Please Select
Excellent
Good
Fair
Poor
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Underwriting Questions
Please note: Missing information may cause a delay in processing
Do you have a property manager?
*
Please Select
Yes
No
Unknown
Property Management Company Name:
Does the property have a Central Fire Alarm?
*
Please Select
Yes
No
Unknown
Does the property have Fire Sprinklers?
*
Please Select
Yes
No
Unknown
Does the property have smoke detectors?
*
Please Select
Hardwired
Battery powered
No
Are there any gas wall heaters?
*
Please Select
Yes
No
Any planned occupancy changes?
Please Select
Yes
No
Any planned construction/remodeling?
Please Select
Yes
No
If yes, please explain:
Ex: estimated cost, timeline, description of changes, etc.
Any insurance claims in the last 5 years?
Please Select
Yes
No
Unknown
Any short-term rentals?
Please Select
Yes
No
Airbnb or VRBO, or for periods shorter than 30 days at a time
Any of the following dog breeds on the property?
Please Select
Akitas
Cane Corsos
Chows
Pit Bulls
Presa Canarios (Canary dog)
Rottweilers
Staffordshire Bull Terriers
Jindos
Wolf Hybrids
Farm Animals
Zoo Animals
Exotic Animals
Any animal with a biting history
More than one of the above
None of the above
Is there galvanized plumbing?
Please Select
Yes
No
Are there fuse panels or aluminum wiring?
Please Select
Yes
No
Are there Federal Pacific, Zinsco, Stab-Lok, Challenger, or GTE-Sylvania electrical panels?
Please Select
Yes
No
Is there a pool or spa? (If yes, how many?)
Please Select
0
1
2
3
4
More than 4
Is there a laundry room?
*
Please Select
Yes
No
If yes, is it managed by a third party?
Please Select
Yes, 3rd party
No, self-managed
Are charcoal grills allowed on balconies?
Please Select
Yes
No
Are there interior hallways in the building(s)?
Please Select
Yes
No
Is the property smoke-free?
Please Select
Yes
No
Is the property primarily for students or seniors?
Please Select
Yes
No
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Wrap Up
Please note: Missing information may cause a delay in processing
Upload any relevant documents (insurance policies, inspection reports, appraisals, offering memorandums, loss runs, etc.)
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Missing information may delay the quoting process
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Who referred you?
*
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
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