• Homeowners Association Insurance Questionnaire

  • Applicant is:
  • 1. Is the Developer out of the picture?
  • 6. Are there any buildings or structures commonly owned?
  • 7. Do you have a Clubhouse?
  • 7b. If yes, is there any commercial cooking on premise?
  • 8. Do you have a pool?
  • 8a. If yes, is there a diving board?
  • 8b. If yes, is there a slide?
  • 8c. If yes, is the pool fenced?
  • 9. Is the association responsible for its own roadways?
  • 10. Is the association responsible for its own water supply (well)?
  • 11. Is the association responsible for its own tax collection?
  • 12. Does the association provide any other services?
  • 13. Do you own or have access to a beach?
  • 13a. If yes, is the beach posted “Swim at your own risk?
  • 13b. If yes, is there a slide into the water?
  • 14. Do you own or have access to a raft?
  • 14a. If yes, is there a diving board?
  • 14b. Is there an aqua trampoline or iceberg?
  • 15. Do you own or have access to a dock?
  • 15b. If yes, is it clearly marked “No Diving”?
  • 16. Do you own or have access to a public boat ramp?
  • 17. Do you own or have access to sports grass/fields?
  • 18. Do you own or have access to playground(s)?
  • 19. Do you own or have access to retainage/fishing ponds?
  • 20. Do you own or have access to an airstrip?
  • 21. Do you own or have access to stable/pastures? (If yes, need to complete Stables Questionnaire.)
  • 22. Do you own or have access to golf course?
  • 23. Do you own or have access to other activities not mentioned above?
  • 24. Is there a man-made dam?
  • 25. Is the Association a “Lake Association” that is responsible for the whole lake?

  • 26. Please attach 5-year Loss Runs, a copy of the By-Laws, and Articles of Incorporation.

  • PROPERTY INSURANCE

  • 1. Do you need Building and/or Content Coverage?
  • Rows
  • 2. Do you need Equipment Coverage?
  • 2a. If yes, total value to insure for?
  • Rows

  • COMMERCIAL AUTOMOBILE INSURANCE

  • 1. Does the business title any automobiles or other operating vehicles in the business name?
  • 2. Is insurance coverage needed for owned automobiles?
  • Rows
  • Rows
  • 3. Do any of the employees, owners or officers drive personally owned automobiles/other vehicles in the course of their work?
  • 3b. Do you verify they have liability coverage?

  • COMMERCIAL CRIME

  • 1. Do you desire coverage for Crime (Employee Dishonesty, Money, Forgery)?

  • COMMERCIAL UMBRELLA

  • 1. Do you need a Commercial Umbrella?

  • DIRECTORS AND OFFICERS & WORKERS' COMPENSATION INSURANCE

  • 1. Do you need Directors and Officers Liability Coverage? (If yes, please contact Kevin Morency.)
  • 2. Do you need Workers Compensation? (If yes, please contact Kevin Morency.)

  • SIGNATURE

  • The information I have provided is true and accurate to the best of my knowledge. I have not willfully concealed or misrepresented any material fact(s) or information. I understand completion of this questionnaire does not compel the company to provide coverage.

  • Questions? 877-244-9090
    Kevin Morency |  kmorency@morencyinsurance.com 

    Morency & Associates Inc.
    141 New Shackle Island Rd, Hendersonville, TN 37075
    Fax: 615-452-6580

    https://clubassociationinsurance.com/

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