Step 2 Multifamily Insurance Questionnaire
Please provide answers to the following questions. When received, we will review and follow up with any questions that need clarification or additional information. If you have any questions at any point, please call or email 503-504-7619 or darring@lacoinsurance.com.
Owner
Building Owner Name *
Your answer
Entity type *
Date business started
MM
/
DD
/
YYYY
Employer Identification Number (EIN)
Your answer
Mail Address
Your answer
Contact Name *
Your answer
Phone *
Your answer
Email *
Your answer
Current Insurance
Please provide answers to following insurance questions.
Number of Claims in past 5 years
Your answer
In the past 5 yrs has any insurance coverage been canceled, or non-renewed?
Name of current Insurance Company providing coverage
Your answer
Current policy Expiration date
Your answer
Management
The questions below pertain to your management and leasing.
Is Management on site?
If off-site, how often are on-site visits conducted?
Who performs the following work?
Snow Removal
Grounds Maintenance
Street & Roads Maintenance
Owners Employee
Property Manager
Independent Contractor
Municipality
Tenant
Management performed by *
If Management is performed by Contracted Property Management, please provide name of property management company.
Your answer
Number of Evictions in last 12 months
Your answer
Class of Residents *
Tenant Screening - please check all that apply
Rental Agreement
For each of the following questions, please provide Yes or No answer.
Tenants are required to sign an annual Lease for the first year?
Lease recommends or requires the tenant obtain Renters Insurance?
Are Gas grills required to be at least 10' from any combustible building?
Are Charcoal grills allowed at any location?
Property
The questions below pertain to the building you are requesting insurance for.
Physical Address *
Your answer
Number of Buildings *
Your answer
Number of Units *
Your answer
Number of Vacant Units
Your answer
Annual Rents *
Your answer
Total building Square Feet *
Your answer
Number of Stories above ground *
Your answer
Square feet of basement
Your answer
Construction type *
Year built *
Your answer
If building is older than 25 years, please provide year and description of most recent replacement for the following Building Systems:
Roof
Your answer
Electrical
Your answer
Plumbing
Your answer
HVAC
Your answer
Any Uncorrected fire & safety code violations?
What is the primary source of Heat for the building? *
Is the property Non Smoking *
Smoke Detector & CO2 Detector - check the applicable option *
Hard wired
10 yr Lithium Battery
N/A
Smoke Detector
CO2 Detector
Does the building have Fire Alarm Pull Stations? *
Is building equipped with a fire suppression Sprinkler System? *
Is Security Patrol service provided?
Recreation Amenities
Recreation - check all that are present
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