SUPPLEMENTAL APPLICATION – APARTMENTS

NEXT: PLEASE FILL OUT THE SUPPLEMENTARY APPLICATION BELOW

HABITATIONAL SUPPLEMENTAL APPLICATION

SECTION I - GENERAL INFORMATION

Applicant Name

DBA

Name *

First

Last

Email *

Title

Address

City

State

Zip

Phone Number

Ext.

Website

Years in business under current management:

Date established:

Type of enterprise:

• Corporation
• LLC
• Individual
• Government entity
• Joint venture
• Non profit
• Partnership
• Limited partnership
• Other:

Area of risk:

• Metro city
• Suburb
• Rural

SECTION II -PREMISES INFORMATION

1. Provide number of Buildings:

Number of Stories:

Number of Units:

2. Type of occupancy:

• Apartments
• Condominium association
• Homeowners association

3. Are there elevators in the building(s)?

• YES
• NO

If “Yes”, is there a maintenance contract in place with a licensed contractor?

• YES
• NO

4. In what year was the building constructed?

5. How many years has applicant owned the building?

as lifeguards Heating:

6. Provide type of construction:

7. In what year were the following updates last performed:

Heating:

Plumbing:

Electrical:

Roofing:

8. Are there any owned parking areas?

• YES
• NO

If “Yes”, approximate square feet:

9. Are animals allowed on premises?

• YES
• NO

If “Yes”, what breed and size restrictions are in place:

10. Does applicant perform background checks on employees and tenants?

• YES
• NO

11. Does applicant have a formal eviction policy in place?

• YES
• NO

If “Yes”, please submit a copy with this completed application.

SECTION III – OCCUPANCY

1. Does applicant have any elderly, disabled or assisted living tenants?

• YES
• NO

If “Yes”, what percentage?

2. Does applicant provide any meals for tenants?

• YES
• NO

3. Does applicant provide transportation for residents?

• YES
• NO

4. Are there pull cords and/or call buttons used to monitor residents?

• YES
• NO

5. Are there pull cords and/or call buttons used to monitor residents?

• YES
• NO

6. Does applicant provide any government or subsidized housing?

• YES
• NO

If “Yes”, what percentage?

7. Does applicant have any student renters?

• YES
• NO

If “Yes”, what percentage?

SECTION IV – MAINTENANCE

1. Is management staff on site?

• YES
• NO

2. Is maintenance staff on site?

• YES
• NO

3. If subcontractors are required to perform any work on the premises, including snow removal, are they required to provide COIs with limits of at least $1,000,000 and name applicant as an additional insured?

• YES
• NO

4. Are there any construction or renovation projects in progress or planned during the coming year?

• YES
• NO

If “Yes”, please explain:

SECTION V – FIRE SAFETY

1. Type of wiring:

• Copper
• Aluminum

IF Aluminum, which type:

• Pigtailed
• Co/ALR

2. Is the facility fully sprinklered?

• YES
• NO

If “No”, what percentage is sprinklered?

3. Are there smoke alarms in each room?

• YES
• NO

If “Yes”, are they:

• Hardwired
• Battery

4. Does the building have a central station alarm?

• YES
• NO

If “Yes”, is it connected to:

• Local fire department
• Outside monitoring service

5. Is there emergency lighting in all common areas (including stairwells)?

• YES
• NO

6. Are there carbon monoxide detectors in each unit?

• YES
• NO

If “Yes”, are they:

• Hardwired
• Battery

7. Are there two means of egress from each floor?

• YES
• NO

If “No”, please explain:

SECTION VI – SWIMMING FACILITIES

1. How many swimming pools are onsite?

Pool hours:

2. Is pool completely fenced?

• YES
• NO

If “Yes”, are there self-closing and latching gates?

• YES
• NO

3. Are gates locked during non-pool hours?

• YES
• NO

4. Are there diving boards or slides?

• YES
• NO

5. Are rules posted?

• YES
• NO

6. Are there lifeguards on duty?

• YES
• NO

7. Do all pool and spa drains conform to the mandated specifications and requirements of the Virginia Graeme Baker Pool and Spa Safety Act?

• YES
• NO

SECTION VII – OTHER RECREATIONAL FACILITIES

1. Are the following recreational facilities available to tenants?

• Tennis courts
• Volleyball courts
• Saunas/spas
• Clubhouse
• Fitness center
• Lakes/ponds/ocean access
• Tanning beds
• Bathing beaches
• Convenience stores
• PlaygroundsKids’ programs/day camps
• Boat rental operations
• Baseball fields
• Basketball courts
• Other (*describe below)

*Other:

2. Describe the ground cover for playground areas as well as the age and type of equipment:

3. Does applicant sponsor or host any athletic events on this premise or the premises of others?

• YES
• NO

4. Will any special events be hosted on applicant’s premises during the upcoming policy period and/or does applicant regularly hold special events at the premises?

• YES
• NO

If “Yes”, will liquor be served at these events?

• YES
• NO

If “Yes”, please describe:

SECTION VIII – SECURITY

1. Are security guards onsite?

• YES
• NO

If “Yes”, are security personnel:

• YES
• NO

a. Employed

• YES
• NO

b. Off-duty police officers

• YES
• NO

c. Subcontracted

• YES
• NO

If “Yes”, are subcontractors required to provide COIs with limits of at least $1,000,000 and name applicant as an additional insured?

• YES
• NO

d. Armed security

• YES
• NO

2. Provide days of the week security is on duty at applicant’s location:

3. Provide hours security guard is on duty:

4. Are background investigations conducted on all employees who perform security duties?

• YES
• NO

SECTION IX – OTHER SERVICES

1. Are there any non-habitational operations on the premises?

• YES
• NO

If “Yes”:

a. What type of occupancy?

b. List the square footage of the occupancy:

Submit

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