Lessor’s Risk Supplemental Application
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Applicant Information
Applicant’s Name
*
Applicant’s Name is required.
Applicant’s Address 1
Applicant’s Address 2
City/State/Zip
Select State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
County
Description of Operation
Eligibility Criteria
Clear All
Yes to all
Applicant is the owner of all properties
Yes
No
Applicant has a lease in place with all occupants whether or not they are involved in ownership
Yes
No
All commercial tenants, other than self-insured governmental entities, are required to carry insurance and the owner/property manager obtains certificates of insurance from all tenants
Yes
No
No tenant(s) of the building are a bar or night club
Yes
No
No commercial cooking with extinguishing systems not in compliance with NFPA #96
Yes
No
No tenant is a medical marijuana grower, hospital, nursing home, assisted living facility, elder care facility or any healthcare facility with an overnight or residential exposure
Yes
No
No past, pending or planned bankruptcy or judgment for unpaid taxes against the named insured or any officer, partner, member or owner of the applicant individually in the past five (5) years
Yes
No
Building & Tenant Information
Years owned by Insured
Select one
0
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Building Square Footage
Number of Stories
Select One
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
5.5
6.0
6.5
7.0
7.5
8.0
8.5
9.0
9.5
10.0
10.5
11.0
11.5
12.0
12.5
13.0
13.5
14.0
14.5
15.0
15.5
16.0
16.5
17.0
17.5
18.0
18.5
19.0
19.5
20.0
20.5
21.0
21.5
22.0
22.5
23.0
23.5
24.0
24.5
25.0
25.5
26.0
26.5
27.0
27.5
28.0
28.5
29.0
29.5
30.0
30.5
31.0
31.5
32.0
32.5
33.0
33.5
34.0
34.5
35.0
35.5
36.0
36.5
37.0
37.5
38.0
38.5
39.0
39.5
40.0
40.5
41.0
41.5
42.0
42.5
43.0
43.5
44.0
44.5
45.0
45.5
46.0
46.5
47.0
47.5
48.0
48.5
49.0
49.5
50.0
50.5
51.0
51.5
52.0
52.5
53.0
53.5
54.0
54.5
55.0
55.5
56.0
56.5
57.0
57.5
58.0
58.5
59.0
59.5
60.0
60.5
61.0
61.5
62.0
62.5
63.0
63.5
64.0
64.5
65.0
65.5
66.0
66.5
67.0
67.5
68.0
68.5
69.0
69.5
70.0
70.5
71.0
71.5
72.0
72.5
73.0
73.5
74.0
74.5
75.0
75.5
76.0
76.5
77.0
77.5
78.0
78.5
79.0
79.5
80.0
80.5
81.0
81.5
82.0
82.5
83.0
83.5
84.0
84.5
85.0
85.5
86.0
86.5
87.0
87.5
88.0
88.5
89.0
89.5
90.0
90.5
91.0
91.5
92.0
92.5
93.0
93.5
94.0
94.5
95.0
95.5
96.0
96.5
97.0
97.5
98.0
98.5
99.0
99.5
100.0
100.5
101.0
101.5
102.0
102.5
103.0
103.5
104.0
104.5
105.0
105.5
106.0
106.5
107.0
107.5
108.0
108.5
109.0
109.5
110.0
110.5
111.0
111.5
112.0
112.5
113.0
113.5
114.0
114.5
115.0
115.5
116.0
116.5
117.0
117.5
118.0
118.5
119.0
119.5
120.0
120.5
121.0
121.5
122.0
122.5
123.0
123.5
124.0
124.5
125.0
Year Built
Parking Square Footage
Vacancy Percentage
Select one
0
5
10
15
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25
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100
If building is over 15 years old, when were the following updates performed
Heating/HVAC
Select one
2026
2025
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2019
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1975
Electrical/Wiring
Select one
2026
2025
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2020
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Plumbing
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2026
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1975
Roof
Select one
2026
2025
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1976
1975
Parking Areas
Select one
2026
2025
2024
2023
2022
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2020
2019
2018
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2016
2015
2014
2013
2012
2011
2010
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1976
1975
List all commercial tenants below
Name of Tenant
Description of Operations
Length of Tenancy
Square Footage Occupied
Action
Add Tenant
General Information
How many years has the applicant been at current location?
Does the applicant occupy and operate out of any portion of the building?
Yes
No
Description of Operations
Are there any ongoing structural renovations or planning during our policy term?
Yes
No
Any apartment units in the building?
Yes
No
Number of units
Are any of the tenants manufacturers?
Yes
No
If so, please describe any manufacturing operations in the building
Are all commercial cooking areas covered by a UL300 extinguishing system?
Yes
No
Are there any Underground Storage Tanks on the property?
Yes
No
If so, What to they contain
Has the property ever received any safety or health code violations?
Yes
No
Do any tenants stay open past midnight?
Yes
No
Contractual Information
Is the landlord/tenant agreement a “Triple Net Lease”?
Yes
No
Does the lease have a provision requiring tenant(s) to maintain general liability insurance with applicant named as additional insured?
Yes
No
Does the lease require tenant(s) to maintain and/or repair the premises, including keeping such premises free of snow and ice, adjacent to the building (e.g., sidewalks, driveways, parking lots, etc.)?
Yes
No
Does the Applicant require all commercial tenants to carry general liability insurance?
Yes
No
Are certificates of insurance obtained confirming coverage?
Yes
No
Applicant named as an additional insured on tenant’s policies?
Yes
No
Hold harmless agreement in place with tenants in favor of applicant?
Yes
No
Tenants’ limits required to be equal to or greater than applicants?
Yes
No
Is the building managed by a professional property management firm?
Yes
No
If YES, is applicant named as an additional insured on Property Manager’s policy?
Yes
No
If a single-occupancy risk, does applicant’s lease agreement require the tenant be responsible for the condition of pavements/curbs associated with the leased premises, including snow and ice removal?
Yes
No
Maintenance
Do you have written procedures for inspecting and maintaining of your premises including parking areas?
Yes
No
Does the Applicant have written procedures in place for responding to tenant complaints?
Yes
No
Who performs building and/or site maintenance,service and repair?
Janitorial operations
Employee
Independent Contractor
NA
Landscaping/lawncare operations
Employee
Independent Contractor
NA
Snow & ice removal
Employee
Independent Contractor
NA
General maintenance & repairs
Employee
Independent Contractor
NA
If done by an independent contractor
Applicant named as additional insured with hold harmless on subcontractor’s policy?
Yes
No
Certificates of insurance obtained and maintained on file?
Yes
No
Are subcontractors required to carry general liability limits greater than or equal to the applicant?
Yes
No
Is there an elevator?
Yes
No
Number of elevators?
Elevator maintenance agreement in effect, naming Applicant as an additional insured with hold harmless
Yes
No
Fire & Safety Information
Is the complex in compliance with all applicable state and local statutes governing safety devices?
Yes
No
Please indicate the type of fire protection on the premises
Fire Extinguishers
Smoke Detectors
Sprinklers
Building Sprinklered
Select One
No Sprinkler System
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Manual Fire Alarm
Yes
No
Central Station Fire Alarm
Yes
No
If over three stories, are interior stairways enclosed and equipped with self-closing fire doors on each floor
Yes
No
Do all buildings/floors have clearly marked fire exits
Yes
No
Emergency lighting provided in all common areas
Yes
No
Security
Is security provided by the applicant?
Yes
No
Cameras
Guards
Other
If security guards are present, please answer the following
Yes
No
Are the guards
Armed
Unarmed
Are the guards
Employees
Independent Contractors
Off-duty police
If independent contractors
Yes
No
Does Applicant obtain a written contract from all subcontractors and certificates of insurance
Yes
No
Does the contract contain a hold harmless clause in favor of the Applicant
Yes
No
Is Applicant named as an additional insured on the subcontractor’s general liability policy
Yes
No
Are parking lots, driveways and walkways well-lighted and maintained
Yes
No
Missing Required Information
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Applicant’s Name:
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