Landlord Insurance Application

Landlord Insurance Application
Named insured
Type of entity
If owned by a trust, please provide full name of trust
Contact name

PrefixFirst NameLast Name
Date of birth*

MonthDayYear
Date
E-mail Address
example@example.com
Contact Number
Mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Year Built
Number of buildings
Number of Floors
Number of rental units
Number of Elevators
Total Square Feet
Number units owner occupied
Is there a basement?

YesNo
Occupancy Rate (%)
List of commercial tenants if any. Please include square footage of each commercial tenant
Type of Construction
Is the building currently under construction?
Type of foundation
Any planned remodeling of the building?
Are any of the submitted locations new construction or renovated down to studs in the past 3 years?
Type of Building
Type of Roof
Year Roof Updated
Year Electrical Updated
Year Water Heater Replaced
Year Plumbing Updated
Year HVAC was replaced
Smoke/Fire alarms?

LocalCentral StationManualAutomaticNone
Smoke detectors in units

Battery operatedHard wiredHard wired w/ battery backup
Smoke detectors in common area

Battery operatedHard wiredHard wired w/battery backupNone
If there has been a gut rehab on this property, what year did it occur?
Carbon monoxide detectors in units per city/state codes

YesNo
Is the community heated by electric baseboard heat?

NoYes
Do individual units have

Wood burning fireplacesGas fireplacesWood burning stovesN/A
Is grilling permitted on balconies or patios?

YesNo
Is there emergency lighting in hallways and stairways?

YesNo
Do you have any section 8 housing?

YesNo
Is there any Student housing?

NoYes
Do you have any elderly or assisted living tenants?

YesNo
What type of electrical in the building?

100% Circuit BreakersKnob and TubeFusesAluminumother
Are tenants allowed to have dogs?

NoYes
Are any of the electrical panels (Sub panels and Main panels) one of the following: Federal Noark, Challenger, Federal Pacific - Stab-Lok, Zinc, Magentrip, Sylvania -Zinsco, or GTE Sylvania-Zinsco?

NoYes
What brand electrical panel does the building have?
# of parking spots
Has the parking area/garage/tuck-under parking area been retrofitted with steal frame, shear walls, or bracing dampers?

YESNO
If there is a garage built-in, attached or detached, please provide the approximate square footage
Year HVAC was updated
Sprinkler Installed(100%)? /All Units

YesNo
Is there a central fire alarm?

YesNo
Is there a central burglar alarm?

YesNo
Annual Rental Income ($)
Any short-term rentals
Is this a senior living complex?

NoYes
Is the building managed by a property management firm? If yes, please provide name and address
Do you require all tenants to carry renters insurance and obtain certificates of insurance on an annual basis?

NoYes
Please upload the pictures or copy of the current policy.

Cancelof
Current Insurance Company
Current Building Coverage ($)
Current Premium ($)
Current Liability Coverage ($)
Current Business Personal Property coverage
Ex. common area furniture
Current Insurance Expiration Date

MonthDayYear
Fire Station Name
How far from the fire station? (miles)
Any optional coverage must be included?
Any claims in the last 3 years?

YesNo
Claim Date and Year?

MonthDayYear
Claim Date and Year?

MonthDayYear
Claim Date and Year?

MonthDayYear
Upload '3 year loss runs'

Please request loss runs from your current and any previous insurance company in the last three year.
Cancelof
Additional insured and/or loss payee?
Lender Name
Bank (Lender) Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Loan #
How did you hear about us?
Should be Empty: