Landlord Habitational/Multi-Family Checklist
Which Agent have you been working with?
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Kory Boersma
Jeff Nolin
Emily Babcock
Karina Gonzalez
Katie Clark
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
Driver's License Number
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Legal Business Name (If applicable)
ex. ABC Company, LLC
FEIN #
Federal Tax ID #
Name (Secondary Point of Contact)
First Name
Last Name
Phone Number (Secondary Point of Contact)
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Area Code
Phone Number
Date of Birth (Secondary)
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Month
-
Day
Year
Date
Email (Secondary Point of Contact)
example@example.com
Driver's License # (Secondary)
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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Home Description
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Apartments - Less than 10 Units
Apartments - More than 10 Units
Duplex
Four Plex
Single Family Home
Construction Type
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Frame - Wood
Frame - Metal
Brick Masonry
Concrete
Basement?
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Yes, unfinished
Yes, partially finished
Yes, fully finished
No
If yes, Sq. Ft
Fireplace?
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Yes, gas
Yes, solid fuel (wood, etc.)
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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Gas Forced Air
Electric
Baseboard
Geothermal
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(s)? Please check all that apply:
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Ring Doorbell
Local Fire Alarm
Local Burglar Alarm
Central Fire Alarm - Must Provide Service Certificate
Central Burglar Alarm - Must Provide Service Certificate
None
Is the property part of a historical registry? (If unsure, this can usually be found on the assessor site)
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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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