Apartment (Mixed Use) Insurance Quote Request Form (Page 3 of 4) in pdf

Apartment (Mixed Use) Insurance Quote Request Form Page 3

*Are any units designated for seasonal or vacation rentals? Y / N

*Does vacancy rate exceed 25%? Y / N

*Over 20% designated student or subsidized/Section 8 occupancy? Y / N

*Gross sales from any restaurant operation exceeds $3,000,000 or 24-hour operation? Y / N

*Does the roof currently leak or have any defects? Y / N

*Is the current roof more than 30 years old? Y / N

*Does the plumbing currently leak or have any defects? Y / N

*Have there been any housing code violation citations issued for the property to be insured? Y / N

*Are you, any of your employees, or your property manager aware of any tenant allegations of living condition

or maintenance issues at the property to be insured? Y / N

Inspection Contact Information

*Contact Name__________________________*Contact Phone____________________

*Email : ___________________________________________

Additional Information

*Parking Type: ________________________ *Roof Type : _____________________________________

*Occupancy Type: ________________________________________

*Annual Rents: $______________________________

*Are there any lakes, ponds, or fountains? Y / N

*Are there plans to evict anyone in next 90 days?

*Number of Tenants Evicted in last 3 years : ____________________________

*Recreational Facilities on Premises

*Plumbing Updates in last 30 years _______________*Year of Last Plumbing Update ________________

Mortgage Company Information

Name: __________________________________________ Loan # ________________________________

Address: _________________________________________ City, State, Zip ___________________________

Bill Mortgage Company at renewal? Y / N

Apartment (Mixed Use) Insurance Quote Request Form Page 3