MULTI-FAMILY APARTMENT HABITATIONAL - Polestar Insurance LLC

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:

4. pull on

Date established:

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)?

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

4. In what year was the building constructed?

5. How many years has applicant owned the building?

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?

If “Yes”, approximate square feet:

9. Are animals allowed on premises?

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

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

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

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

SECTION III – OCCUPANCY

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

If “Yes”, what percentage?

2. Does applicant provide any meals for tenants?

3. Does applicant provide transportation for residents?

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

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

6. Does applicant provide any government or subsidized housing?

If “Yes”, what percentage?

7. Does applicant have any student renters?

If “Yes”, what percentage?

SECTION IV – MAINTENANCE

1. Is management staff on site?

2. Is maintenance staff on site?

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?

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

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?

If “No”, what percentage is sprinklered?

3. Are there smoke alarms in each room?

If “Yes”, are they:

Hardwired
Battery

4. Does the building have a central station alarm?

If “Yes”, is it connected to:

Local fire department
Outside monitoring service

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

6. Are there carbon monoxide detectors in each unit?

If “Yes”, are they:

Hardwired
Battery

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

If “No”, please explain:

SECTION VI – SWIMMING FACILITIES

1. How many swimming pools are onsite?

Pool hours:

2. Is pool completely fenced?

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

3. Are gates locked during non-pool hours?

4. Are there diving boards or slides?

5. Are rules posted?

6. Are there lifeguards on duty?

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

SECTION VII – OTHER RECREATIONAL FACILITIES

*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?

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?

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

If “Yes”, please describe:

SECTION VIII – SECURITY

1. Are security guards onsite?

If “Yes”, are security personnel:

a. Employed

b. Off-duty police officers

c. Subcontracted

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

d. Armed security

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?

SECTION IX – OTHER SERVICES

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

If “Yes”:

a. What type of occupancy?

b. List the square footage of the occupancy:

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