Condo Association
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Insureds Name
*
Insureds Name is required.
Contacts Name
Contacts Title
Ownership of Units:
Individual Owned %
Developer Owned %
Bank Owned %
Occupancy of Units:
Owner Occupied %
Rented / Leased %
Vacant %
If rented or leased, which of the following apply?
Students
Elderly
Seasonal
None Apply
Are Unit owners required to maintain insurance?
Yes
No
If yes, how do you monitor compliance with insurance requirements?
Are unit owners permitted to have dogs?
Yes
No
If Yes, list breed restrictions
Select One
Affenpinscher
Akita
American Bulldog
Australian Terrier
Beagle
Bichon Frise
Bolognese
Border Terrier
Boxer
Brussels Griffon
CaneCorso
Cavalier King Charles Spaniel
Chihuahua
Chinese Crested
Chow
Collie
Coton De Tulear
Dalmation
Doberman
English Sheepdog
English Toy Spaniel
German Shepherd
Golden Retriever
Great Dane
Havanese
Husky
Irish Setter
Italian Greyhound
Jack Russell Terrier
Jin Do
Labradoodle
Labrador Retriever
Lancashire Heeler
Lhasa Apso
Lowchen
Maltese
Mastiff
Minature Pinscher
Norfolk Terrier
Norwich Terrier
Papillon
Pekingese
Pit Bull (American Staffordshire Terrier)
Pomeranian
Poodle (Standard)
Poodle (Toy or Miniature)
Presa Canarios
Rottweiller
Schnauzer
Sharpei
Sheltie
Shiba Inu
Shih Tzu
Shitzu
Silky Terrier
St. Bernard
Tibetan Spaniel
Toy Fox Terrier
Weimaraner
Yorkie
Other (then describe)
Sprinkler System
Yes
No
If Yes % of Building Sprinklered
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
Please indicate unsprinklered area
Sprinkler Type
Wet Pipe
Dry pipe
Sprinklers insulated between Walls and Attic Areas
Yes
No
Are any Sprinklers located on outer Building Walls
Yes
No
If Sprinklers not insulated, has Antifreeze Solution been added?
Yes
No
Is there a water tank on premise
Yes
No
If Yes, is the water tank inspected and serviced annually for both water quality and structural issues?
Yes
No
Serviced by
Last Inspection Date
What kinds of Carbon Monoxide / Smoke Detectors are used in the buildings
Battery in units and all common areas
Battery in units and hard-wired in common areas
Hard-wired throughout
Manual pull alarms in common areas
None
Type of Wiring:
Copper
Aluminum
Pigtailed
CO/ALR
Is maintenance staff on site?
Yes
No
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
Is there a Home Owner Association (HOA) in place?
Yes
No
Does the Home Owner Association maintain Directors, Officers and Organization Liability?
Yes
No
Insurance Company:
Limits of Liability:
Select One
25/50
50/100
100/300
250/500
250/1 Million
50 CSL
100 CSL
300 CSL
500 CSL
1 Million CSL
2 Million CSL
3 Million CSL
4 Million CSL
5 Million CSL
Policy Period:
How many members are there in the Home Owner Association?
Select one
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
What is the annual total of fees collected by the Home Owner Association?
Is the Home Owner Association responsible for the maintenance or operation any of the following?
Club House / Community Room
Playground
Lake/Pond
Exercise Room/Fitness Center
Swimming Pool(s)
Hot Tub / Jacuzzi
Tennis / Basketball Court(s)
Guard House
Irrigation System
Sewage Treatment/Septic System
Parking Area/Roads
Other
Condominium / Cooperative Supplemental Application
Club House
Yes
No
Is access restricted to Unit Owners?
Yes
No
If no, is there a written agreement for use of Club House / Community Room?
Yes
No
Is cooking within the Club House / Community Room permitted?
Yes
No
Health Club/Exercise Room
Yes
No
Is access restricted to ONLY the Unit Owners and their guests?
Yes
No
Are rules posted regarding use of the equipment?
Yes
No
Who is responsible for maintenance of the equipment?
Unit Owners
Employee
Contractor
How often is equipment inspected?
Tennis Court/Playground
Yes
No
If yes, how many:
Is there a playground on premises?
Yes
No
If yes, how many:
Is playground equipment in good condition?
Yes
No
How often is playground equipment inspected?
Is the playground area fenced?
Yes
No
Describe the surface under the playground equipment:
Swimming Pool
Yes
No
If yes, how many:
Is the pool area fenced?
Yes
No
Is the fencing equipped with self locking gates?
Yes
No
Is there a diving board or slide?
Yes
No
If yes, how many:
Is the pool equipment with an unblockable drain or Safety Vacuum Release System?
Yes
No
Are rules posted regarding use of the pool or hot tub?
Yes
No
Is there a Lifeguard on duty at all times?
Yes
No
Who is responsible for maintenance of the pool or hot tub?
Unit Owners
Employee
Contractor
Is there a written maintenance schedule, including checking all life safety equipment?
Yes
No
Missing Required Information
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