Casey Insurer Services
SMP and OL&T FORM
Company:
*
Jencap
DeCotis Insurance - MA
DeCotis Insurance - RI
Johnson & Johnson Insurance
Market Finders Insurance
Jencap/Quaker Special Risk
Safety Insurance
Insured Name:
*
Policy #:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Agency:
*
Inspector's Name:
*
William Bierce
Keith McEachern
Bill Casey
John Frank
Jim McEachern
David Morin
Charles Lyons
Greg McEachern
Ashley Freudenthal
Nicole Messier
Mark Kramer
Dick Herman
Austin Giese
Matt Bodman
Tyler McQuade
Latania Knights
Kristian Mahaffey
Erick Hartz
Inspection Date:
*
-
Month
-
Day
Year
Date Picker Icon
Met With:
*
Insured
Owner
Property Manager
Assistant
Tenant
Caretaker
Employee
Friend
Family Member
Business Partner
Realtor
Contractor
Wife
Husband
Mother
Father
Son
Daughter
Sister
Brother
Lock Box
Left Open
Left Key for Inspector
Exterior Only
No One
N/A
NO SHOW
NO SHOW - see last page for details
Person you met with
Contact Name:
First Name
Last Name
Contact Information:
Enter phone numbers & email addresses
Owned Property:
*
How long has the insured owned the risk?
Total Living Square Footage:
*
Type of Risk/Description:
*
Prior Loss:
*
Yes
No
Unknown
Prior Loss Description:
Click Here For NO SHOW
Contacted Insured Via:
Phone
Phone Voicemail
Text Message
Email
Other
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Contacted Insured Via:
Phone
Phone Voicemail
Text Message
Email
Other
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Contacted Insured Via:
Phone
Phone Voicemail
Text Message
Email
Other
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Was agency contacted by inspector?
Yes
No
Other
Date Agency Contacted:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Agent's Name:
First Name
Last Name (if you have it)
The insured
was unresponsive
confirmed the appointment but did not show
Other
Additional Information:
Additional information regarding no show
Click Here For Occupancy
Occupancy
If multi-unit, enter occupancy for each floor below.
Basement:
List basement occupancy
First Floor:
List 1st floor occupancy
Second Floor:
List 2nd floor occupancy
Third Floor:
List 3rd floor occupancy
Fourth Floor:
List 4th floor occupancy
Occupancy (if above doesn't apply)
Any subsidized or Section-8 tenants?
No
Yes
Unable to verify with insured
Property is vacant
Other
Screening process for tenants:
Background check
First, last, security
Credit check
Application
Reference check
Unable to verify with insured
Property is vacant
Other
Area/Type of Neighborhood
Area
Type of Neighborhood
*
Residential
Commercial
Industrial
Area
*
Urban
Suburban
Rural
Area Security/Safety
*
Good
Fair
Poor
Click Here For Construction
Construction
Age of Building:
*
120 Years Old
# of Stories:
*
1
1.5
2
2.5
3
3.5
4
4.5
5
6
7
8
9
10+
Foundation:
*
Concrete
Brick
Fieldstone
Concrete Block
Concrete Slab
Crawl Space
Pylons
Granite Block
Other
Basement Usage:
*
Finished Area
Utilities
Storage
No Basement
Other
Exterior Frame:
*
Wood Frame
Steel Frame
Concrete Block
Brick
Other
Exterior Siding:
*
Vinyl
Wood Clapboard
Wood Shingles
Cement Fiber Clapboard
Brick
Concrete Block
Aluminum
Asbestos Shingles
Asphalt Shingles
Stucco
Steel Sheathing
T1-11 Wood Siding
Metal
Vinyl Shake Shingles
Other
Roof Type:
*
Flat
Gable
Hip
Mansard
Gambrel
Sloped
Other
Roof Deck:
*
Wood
Steel
Concrete
Other
Roof Covering:
*
Asphalt Shingles
Rubber Membrane
Tar & Gravel
Wood Shake
Slate
Metal
Other
Roof Age:
*
New
Less than one year
1-5 years
5-10 years
10-15 years
15-20 years
20-25 years
Over 25 years
Original
Unknown/Not Visible
Garage Roof- good condition
Garage Roof- fair condition
Garage Roof- poor condition
Other
Interior Walls & Ceilings:
*
Wood Frame
Steel Frame
Concrete Block
Brick
Wall Covering:
*
Drywall
Plaster-lath
Wood Paneling
FRP Paneling
Brick
Concrete Block
Exposed/Studs
Other
Ceiling:
*
Drywall
Plaster
Suspended
Wood
Exposed/Open
Other
Flooring:
*
Wood Joists
Concrete
Steel Supports
Floor Coverings:
*
Hardwood
Tile
Carpet
Vinyl
Concrete
LVP
Linoleum
Subflooring
Engineered hardwood
Other
Off Street Parking:
*
No
Yes
Other
Garage:
*
None
Attached 1 Car
Attached 2 Car
Attached 3 Car
Detached 1 Car
Detached 2 Car
Detached 3 Car
One Car Under
Two Car Under
Other
Overall Condition of Building:
*
Excellent
Good
Fair
Poor
Click Here For Utilities
Utilities
Heating/Cooling System(s):
*
Gas Forced Hot Water
Oil Forced Hot Water
Gas Forced Hot Air
Oil Forced Hot Air
Gas Steam
Oil Steam
Gas/Electric HVAC
Central Air Conditioning
Electric Baseboard
Electric Wall Monitor
Gas Wall Monitor
Gas Ceiling Unit
Electric Ceiling Unit
Gas on Gas Stove
Gas Parlor Stove
Wood Stove
Pellet Stove
Wood Fireplace
Gas Fireplace
Gas Radiant
Oil Radiant
Electric Split Air System
Gas Hydro-Air System
No Heat
No Access
Other
No. Heating Units:
*
None
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
Multiple
Unknown
Type of Plumbing:
*
Copper
Cast Iron (gas line)
Cast Iron (waste line)
PVC
PEX
Flex Pipe
ABS
Brass
None
No Access
Other
Electrical:
*
Breakers
Fuses
No Access
None
Other
Total Amperage:
60
100
125
200
400
No Access
Other
Breaker Panel Amperage:
*
60
100
125
150
200
No Access
Other
No. Electrical Panels:
*
No Access
Multiple
One
Two
Three
Four
Five
Six
None
Breaker Panel Manufacturer
*
Challenger
Federal Pacific (Stab-Lok Breakers)
Zinsco or Zinsco-Sylvania
Murray Electric
Scott Electric Co
Square D
Siemens
Eaton
Cutler-Hammer
Bryant
General Electric
Crouse Hinds
Westinghouse
Bulldog Pushmatic
I.T.E.
Other
Does the risk have a Square D breaker panel?
*
Yes
No
Other
If yes, enter the date code (examples below)
Electrical Wiring:
*
Romex
BX
Cloth Romex
MC
Commercial Cable
No Access
None
Other
Active Knob & Tube:
*
No
No Interior Access
Yes
Other
Utility Updates
Heating:
*
New
Within 5 Years
Within 10 Years
Within 15 Years
Within 20 Years
Within 30 Years
Original
Updating During Renovations
No Access
Other
Heating (System 2):
New
Within 5 Years
Within 10 Years
Within 15 Years
Within 20 Years
Within 30 Years
Original
Updating During Renovations
No Access
Other
Heating (System 3):
New
Within 5 Years
Within 10 Years
Within 15 Years
Within 20 Years
Within 30 Years
Original
Updating During Renovations
No Access
Other
Heating (System 4):
New
Within 5 Years
Within 10 Years
Within 15 Years
Within 20 Years
Within 30 Years
Original
Updating During Renovations
No Access
Other
Plumbing:
*
New
Within 5 Years
Within 10 Years
Within 15 Years
Within 20 Years
Within 30 Years
Original
Updating During Renovations
Partial Updates
No Access
Other
Electrical:
*
New
Within 5 Years
Within 10 Years
Within 15 Years
Within 20 Years
Within 30 Years
Original
Updating During Renovations
Gut Rehab Updates (No original wiring or electrical)
Major Updates (All new electrical components, wiring, breakers)
Minor Updates (outlets, switches, electrical fixtures)
Updates Include:
Wiring
Light fixtures
Outlets
Switches
Breaker Panel(s)
No Access
Other
Hot Water Tank:
New
Within 5 Years
Within 10 Years
Within 15 Years
Within 20 Years
Original
Tankless
No Access
Other
Overall Utility Condition:
*
Good
Fair
Poor
N/A
Utility Hazards:
*
Yes
No
Click Here For Protection
Protective Measures
Common Areas/Main Building:
*
Hardwired Smoke Detectors
Hardwired Carbon Monoxide Detectors
Heat Detectors
Battery Smoke Detectors
Battery Carbon Monoxide Detectors
Plug-In Carbon Monoxide Detectors
Wet Sprinkler System
Dry Sprinkler System
Emergency Lighting
Illuminated Exit Signs
Exit Signs
Exit Bars on Doors
Strobes
Klaxons
Fire Pull Stations
Video Surveillance
Security Grates
Fire Escape
Whole House Backup Generator
No Interior Common Areas
No Interior Access
None
Other
Apartment Unit(s):
Hardwired Smoke Detectors
Hardwired Carbon Monoxide
Heat Detectors
Battery Smoke Detectors
Battery Carbon Monoxide
Plug-In Carbon Monoxide
Combination Smoke & Carbon
Wet Sprinkler
Strobes
Klaxons
Fire Pull Stations
Video Surviellance
Burglar Alalrm
Other
Fire Extinguisher:
ABC
K-Class
Tagged
Other
Hood & Duct System
Up-To-Date
Not Up-To-Date
No Tag
Other
Fire Suppression System
Up-To-Date
Not Up-To-Date
No Tag
Other
Sprinkler System
Up-To-Date
Not Up-To-Date
No Tag
Other
Alarms:
*
Central Station Fire
Internal Fire
Fire Alarm Panel (normal operations)
Fire Alarm Panel (trouble with system)
No Access to Fire Panel
Central Station Burglar
Internal Burglar
None
Other
Fire Hydrant:
*
Within 50 Feet
Within 100 Feet
Within 200 Feet
Within 500 Feet
None
Suction Point
Other
Fire Department:
*
Paid
Volunteer
Within 500 Feet
Within 1 Mile
Within 2 Miles
Within 3 Miles
Within 5 Miles
None
Other
Click Here If Vacant
Vacant, Locked & Secure:
Yes
Other
How Often Checked:
Daily
Multiple Times Per Week
Weekly
Bi-Weekly
Monthly
Every 2-3 Months
Other
Utilities Being Maintained:
Electric On
Plumbing On
Heating On
Electric Off
Plumbing Off
Heating Off
Winterized
Other
Under Renovation:
Yes
No
Other
Type of Renovations:
Exterior Siding
Roofing
Windows
Interior Walls/Ceilings
Flooring
Kitchen
Baths
Heating Updates
Electrical Updates
Plumbing Updates
Adding Second Story
Decks
Adding Garage
Cosmetics
Full Rehab
Other
Start Date:
Example: May 2019
Completion Date:
Example: May 2019
Project Costs:
Example: $25,000
Plans for Risk Upon Completion:
Sell
Rent
Primary Residence
Not Sure
Other
Builders Risk Supplement:
Contractor's Name:
Years Experience:
Construction Manager:
Percentage Subcontracted:
Type of License:
Construction Supervisors License
Home Improvement Contractors License
None
Other
Certificates of Insurance from Contractors:
Yes
No
Other
Additional Information:
Click Here For Swimming Pool
Swimming Pool:
Yes
No
Swimming Pool Type:
In-Ground
Above Ground
Diving Board
Water Slide
Other
Security of Area:
Secured
Fenced With Locked Gate
Not Secure
Rules/Signs Posted
Lifeguard
Other
Click Here For Exposures
Exposures
LEFT EXPOSURE
No. Feet:
*
Abuts
Attached
Within 5 feet
Within 15 feet
Within 25 feet
Within 50 feet
Within 100 feet
Within 200 feet
Within 300 feet
Within 500 feet
Occupancy:
*
Single Family
Two Family
Multi-Family
Apartment Building
Mixed Use
Commercial Building
Commercial Unit
Wooded Area
Vacant Land
Pond
Lake
Park
Playground
Other
RIGHT EXPOSURE
No. Feet:
*
Abuts
Attached
Within 5 feet
Within 15 feet
Within 25 feet
Within 50 feet
Within 100 feet
Within 200 feet
Within 300 feet
Within 500 feet
Occupancy:
*
Single Family
Two Family
Multi-Family
Apartment Building
Mixed Use
Commercial Building
Commercial Unit
Wooded Area
Vacant Land
Pond
Lake
Park
Playground
Other
REAR EXPOSURE
No. Feet:
*
Abuts
Attached
Within 5 feet
Within 15 feet
Within 25 feet
Within 50 feet
Within 100 feet
Within 200 feet
Within 300 feet
Within 500 feet
Occupancy:
*
Single Family
Two Family
Multi-Family
Apartment Building
Mixed Use
Commercial Building
Commercial Unit
Wooded Area
Vacant Land
Pond
Lake
Park
Playground
Other
Click Here To List Hazards
Hazards & Recommendations
HAZARDS & RECOMMENDATIONS:
*
Yes- See below.
None
Hazard 2025-01:
Recommendation:
Hazard One Photo:
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of
Hazard 2025-02:
Recommendation:
Hazard Two Photo:
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Hazard 2025-03:
Recommendation:
Hazard Three Photo:
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Hazard 2025-04:
Recommendation:
Hazard Four Photo:
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of
Hazard 2025-05:
Recommendation:
Hazard Five Photo:
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of
Hazard 2025-06:
Recommendation:
Hazard Six Photo:
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of
Additional Hazards/Concerns:
Additional Hazard Photos:
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of
Click Here to upload photos
Exterior Front Pictures:
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of
Exterior Side Pictures:
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Exterior Rear Pictures:
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Roof Pictures:
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Remaining Exterior Pictures:
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Outbuilding Pictures:
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Interior Pictures:
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Kitchen Pictures:
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Bathroom(s) Pictures:
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Heating & Cooling Pictures:
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Electrical System Pictures:
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Water Heater Pictures:
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Additional Utility Pictures:
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Protective Pictures:
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Sprinkler System Pictures:
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Swimming Pool Pictures:
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