Apartment/dwelling Supplemental Application Form 2009
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4Apartment/Dwelling Supplemental Application
APPLICANT INFORMATION
Applicant Name:
AKA / DBA:
Mailing Address:
Loc #
Blg #
Address
City
State
Zip Code
Insured Contact:
Phone:
Website:
Yrs in Business:
Yrs Experience:
GENERAL INFORMATION
Loc
/ Bldg
Loc
/ Bldg
Loc
/ Bldg
# of Stories:
# of Units:
Construction:
# of Units Vacant:
Year Built:
If over 15 years old, when were the following updated:
Heating
Electrical
Plumbing
Roof
Are cooking facilities provided in rooms?
Yes
No
Yes
No
Yes
No
If “Yes”, # of rooms:
# of Years the facility owned by the insured:
Does owner / manager live on premises?
Yes
No
Yes
No
Yes
No
FIRE/LIFE SAFETY & SECURITY
Loc
/ Bldg
Loc
/ Bldg
Loc
/ Bldg
Are there heat and smoke detectors in all rooms?
Yes
No
Yes
No
Yes
No
If “Yes”, type of detector:
Are there fire extinguishers on premises?
Yes
No
Yes
No
Yes
No
Is there a central station fire alarm?
Yes
No
Yes
No
Yes
No
Are hallways and stairwells:
open
closed
open
closed
open
closed
Number of exits:
Are sliding doors equipped with additional locks?
Yes
No
Yes
No
Yes
No
Are there dead bolts on individual unit entry doors?
Yes
No
Yes
No
Yes
No
Do individual unit doors have with wide angle one-way peep
Yes
No
Yes
No
Yes
No
holes?
Do you change individual unit door locks immediately upon
Yes
No
Yes
No
Yes
No
termination of a lease or eviction of a tenant?
Are there fences surrounding the property?
Yes
No
Yes
No
Yes
No
Does complex directly employ security guards?
Yes
No
Yes
No
Yes
No
If “Yes”, are they armed?
Yes
No
Yes
No
Yes
No
If outside security guard service, are certificates of insurance
Yes
No
Yes
No
Yes
No
required?
Seneca Apartment Supplemental
1
09/09
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Parent category: Business