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Tenant Liability Insurance

"*" indicates required fields

Step 1 of 2

50%

Name

This field is for validation purposes and should be left unchanged.

Complete this application for each location

Applicant Information

Company Name*

Contact Name*

First Last

Address*

Street Address City State ZIP Code

Email

Phone*

Fax

Applicant Information

Property Name*

Address*

Street Address City State ZIP Code

Manager's Name*

First Last

Email Address

Phone*

Fax

# of Units in property*

Occupancy %*

# of Bldgs*

# of stories*

Year built*

Does the project have any rent regulated units?*

Yes

No

If yes, How many?*

Does the project have any Student Housing units?*

Yes

No

If yes, How many?*

Does the project have any assisted living units?*

Yes

No

If yes, How many?*

Do you obtain Credit Reports for each renter prior to leasing?*

Yes

No

Do you run a Criminal Background Check on all the renters prior to leasing?*

Yes

No

Building construction*

Roof Construction*

Type of Wiring*

Aluminum

Copper

If Aluminum, what % location*

%

Location

Is Aluminum, Updated?*

Yes

No

Sprinklers?*

Yes

No

Where?*

Battery Op Smoke Detectors in all Apts & all Common Areas*

Yes

No

Where?*

Hard Wire Smoke Detectors in all Apts & all Common Areas*

Yes

No

Where?*

Please provide Update year if building is over 15 years old

Plumbing (date)

Roof (date)

Electric (date)

Heat/AC (date)

Other Updates

Yes

No

Please list other updates*

Name

Date

Have you incurred any property losses in the past 3 years?*

Yes

No

If so, Please List the following*

Cause of Loss

Date of Loss

Amount of Loss

*verification of a 3 year loss run from your primary insurance agent MUST accompany this application

File

Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.

Pleas upload any and all documents such as verification of a 3 year loss run from your primary insurance agent.

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