Landlord Habitational/Multi-Family Checklist
Which Agent have you been working with?
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Kory Boersma
Jaime Leiva
Kevin Pham
Emily Babcock
None-New Customer
Name (Primary Point of Contact)
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First Name
Last Name
Date of Birth
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-
Month
-
Day
Year
Date
Phone Number
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-
Area Code
Phone Number
Email
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example@example.com
Legal Business Name (If applicable)
ex. ABC Company, LLC
Name (Secondary Point of Contact)
First Name
Last Name
Phone Number (Secondary Point of Contact)
-
Area Code
Phone Number
Date of Birth (Secondary)
-
Month
-
Day
Year
Date
Email (Secondary Point of Contact)
example@example.com
FEIN #
Federal Tax ID #
Years in Business/Landlord Experience
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In Years
Years with Current Insurance Provider
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In Years
Estimated Closing Date/Requested Effective Date
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-
Month
-
Day
Year
Date
Property Address (to be quoted):
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Street Address
City & State
Zip Code
County
Postal / Zip Code
Mailing Address (if different)
Street Address
City & State
Zip Code
County
Postal / Zip Code
How many residential units on the property?
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Number of apartments/condos/etc.
What is the estimated occupancy? (%)
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Estimated percentage of units being rented at any given time
Any special classes of tenants?
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Student Housing
Designated Elderly Housing
Subsidized Housing/Sec 8
None of the above
List 3 Year Loss History
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List all claims that have been filed in the last three years. Please include what type of claim, damages, and paid amounts for each if available. If none, please type 'none."
Dwelling:
Year Built
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Construction Type:
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(i.e. Frame, masonry)
Home/Building Description
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(ie. duplex, 4-plex, multi-story apartments, single family home)
Basement?
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Yes
No
If yes, Sq. Ft
Fireplace?
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Yes, gas
Yes, solid fuel
No
Sprinklers?
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Yes, full
Yes, partial
No
Wood Burning Stove?
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Yes
No
Type of Heating:
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(ie. gas forced air, electric, etc.)
Secured entry or gated community?
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Yes, gated community
Yes, secured entry to building(s)
None
Type of Electrical
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Circuit Breaker
Fuses
Smoke Detectors?
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Yes
No
Alarm System?
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Yes
No
Usage
Pool?
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Yes
No
Any Pets Allowed?
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Yes
No
If yes, are there any breed or weight restrictions?:
List breeds/weights of animals not allowed on premises
Year of Updates:
Wiring
Complete
Partial
Heating:
Complete
Partial
Plumbing:
Complete
Partial
Roof:
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Complete
Partial
Describe any other buildings on this specific property, if any
Describe any other properties or any comments/questions
Please attach documents (if requested)
Enter the message as it's shown
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Signature
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