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

Date

E-mail Address

example@example.com

Contact Number

Format: (000) 000-0000.

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

Purchase date

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?

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 Replaced

Year Electrical Replaced/Updated

Year Water Heater Replaced/updated

Year Plumbing Replaced/Updated

Year HVAC was replaced/updated

Does the home have an automatic water shut-off valve?

Smoke/Fire alarms?

Smoke detectors in units

Smoke detectors in common area

If there has been a gut rehab on this property, what year did it occur?

Carbon monoxide detectors in units per city/state codes

Is the community heated by electric baseboard heat?

Do individual units have

Is grilling permitted on balconies or patios?

Is there emergency lighting in hallways and stairways?

Do you have any section 8 housing?

Is there any Student housing?

Do you have any elderly or assisted living tenants?

What type of electrical in the building?

Are tenants allowed to have dogs?

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?

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?

If there is a garage built-in, attached or detached, please provide the approximate square footage

Sprinkler Installed(100%)? /All Units

Is there a central fire alarm?

Is there a central burglar alarm?

Annual Rental Income ($)

Any short-term rentals

Is this a senior living complex?

Is the building managed by a property management firm? If yes, please provide name and address

If so, how many years?

Do you require all tenants to carry renters insurance and obtain certificates of insurance on an annual basis?

Please upload the pictures or copy of the current policy.

Current Insurance Company

Current Building Coverage ($)

Current Premium ($)

Current Liability Coverage ($)

Current Business Personal Property coverage

Ex. common area furniture

Have all locations submitted had continuous property and liability insurance in place for the past 3 years?

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?

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.

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?