Casey Insurer Services
Vacant Land 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
Ashley Freudenthal
Nicole Messier
Charles Lyons
Greg McEachern
Mark Kramer
Dick Herman
Matt Bodman
Tyler McQuade
Latania Knights
Kristian Mahaffey
Erick Hartz
Inspector's Email:
Enter your email if you'd like to edit this report in the future
Inspection Date:
*
-
Month
-
Day
Year
Date Picker Icon
Contact Name:
First Name
Last Name
Met With:
Insured
Property Manager
Assistant
Tenant
Caretaker
Employee
Friend
Business Partner
Realtor
Contractor
Wife
Husband
Mother
Father
Son
Sister
Brother
Uncle
Aunt
Cousin
Nephew
Niece
Grandchild
NO SHOW
Lock Box
Left Open
Exterior Only
N/A
Person you met with
Contact Information:
Enter phone numbers & email addresses
Type of Risk/Description:
*
Total Living Square Footage:
Leave blank if no building
Owned Property:
Leave Blank if Tenant Only
Prior Loss:
*
Yes
No
Unknown
Prior Loss Description:
Click Here For Occupancy
Occupancy
How is risk utilized?
Area/Type of Neighborhood
Area
Type of Neighborhood
*
Residential
Commercial
Industrial
Area
*
Urban
Suburban
Rural
Area Security/Safety
*
Good
Fair
Poor
Off Street Parking:
*
No
Yes
Other
Click Here For Utilities
Utilities
*
None
Yes
Other
Type of Plumbing:
Copper
Cast Iron
PVC
PEX
Flex Pipe
ABS
Brass
No Access
Other
Electrical:
Breakers
Fuses
Temporary Drop
No Access
Other
Amperage:
60
100
125
200
400
No Access
Other
Electrical Wiring:
Romex
BX
Cloth Romex
MC
Commercial Cable
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
Original
Updating During Renovations
Partial Updates
No Access
Other
Overall Utility Condition:
Good
Fair
Poor
N/A
Utility Hazards:
Yes
No
Click Here For Protection
Protective Measures
Fire Extinguisher:
ABC
K-Class
Tagged
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
Signs Posted:
No Trespassing
Private Property
Speed Limit
Swim At Your Own Risk
No Diving
Other
Fenced Lot:
Yes, locked & Secure
Yes, not secure
Partially
Other
Additional Protective Measures:
Click Here If Vacant
How Often Checked:
Daily
Multiple Times Per Week
Weekly
Bi-Weekly
Monthly
Every 2-3 Months
Other
New Construction:
Yes
No
Other
Construction Type:
Start Date:
Example: May 2019
Completion Date:
Example: May 2019
General Contracting Company:
Construction Supervisor:
Enter First & Last Name
Years Experience:
With this type of construction
Percentage Subcontracted:
Enter % sub contracted to others
Type of License:
Unrestricted Construction Supervisors License
Home Improvement License
Construction Supervisors License
None
Other
Project Costs:
Example: $25,000
Plans for Risk:
Sell
Rent
Primary Residence
Not Sure
Other
Click Here For Swimming Pool
Swimming Pool:
Yes
No
Other
Swimming Pool Type:
In-Ground
Above Ground
Diving Board
Water Slide
Other
Boat Dock/Slips:
Yes
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
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
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
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:
Browse Files
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of
Hazard 2025-02:
Recommendation:
Hazard Two Photo:
Browse Files
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of
Hazard 2025-03:
Recommendation:
Hazard Three Photo:
Browse Files
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of
Hazard 2025-04:
Recommendation:
Hazard Four Photo
Browse Files
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of
Hazard 2025-05:
Recommendation:
Hazard Five Photo:
Browse Files
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of
Hazard 2025-06:
Recommendation:
Hazard Six Photo
Browse Files
Cancel
of
Additional Hazards/Concerns:
Additional Hazard Photos:
Browse Files
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of
Exterior Pictures:
Browse Files
Include at least one front & back photo of risk
Cancel
of
Protective Measure Photos:
Browse Files
Fire Alarm Panel, Fire Extinguishers, Sprinkler Tags, Etc.
Cancel
of
Upload Construction Photos:
Browse Files
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of
Utility Pictures:
Browse Files
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of
Swimming Pool Pictures:
Browse Files
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of
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