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Tenant Liability Insurance

"*" indicates required fields

Step 1 of 2

50%

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)

MM slash DD slash YYYY

Roof (date)

MM slash DD slash YYYY

Electric (date)

MM slash DD slash YYYY

Heat/AC (date)

MM slash DD slash YYYY

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.

Comments

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

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