Ted W. Allen & Associates Insurance
Multi-Family Habitational Risk Questionaire
FAX (281)378-7501 WATS (800)764-0424
PH (281) 378-7500
Website/Email: www.tedwallen.com
Property Name
Property Address
County
State
9 Digit Zip
Type of Property
Select One
Apartments
Condominiums
Townhomes
Other
Building Construction
Select One
BV
Frame
Stucco
Other
Within City Limits
Year Last Rehabbed
Ext:
Int:
# Of Buildings
Roof Construction
Select One
Comp
Built-Up
Flat
Other
# Of Stories
Average Age of Roof
/ Newest:
/ Oldest:
# Of Units
Roof Condition
Select One
Excellent
Good
Poor
# Subsidized Units
Wiring
Copper
%
PigTail
%
Co/Lar
%
Aluminum
%
Cop/Alum
%
Total Sq. Ft. of all Bldgs
# of Playgrounds
# of Sports Courts
Year Built (Completed)
Condition of Equipment
Select One
Excellent
Good
Poor
Smoke Alarms
Equipment Maintenance
Select One
Excellent
Good
Poor
Battery / Hardwired
/
# of Lakes / # of Retention Ponds
Lakes:
/ Ponds:
Monitored Alarms
# of Swimming Pools
Fire Sprinkler Systems
Pool Hours
Fire Extenguishers Inside
Pool Fenced
Security Officers
Self-Locking Gates
Provided By
Diving Boards or Water Slides
Armed
Depth Marked
Do they Provide Cert of Ins
Shepherd Hooks
Courtesy Patrol
Life Ring
Gate Attendant
Lifeguard
Electric Gate
Exercise Room
Key Card Accessed
Club House
Carports
Condition of Equipment
Select One
Excellent
Good
Poor
Garages
Total Building Value
Location of Garages
Total Content Value
Lighting
Select One
Excellent
Good
Poor
Gross Potential Annual Rents
Coverage Effective Date
Boiler/Machinery Coverage Desired
Please attach: (A) Site Plan, (B) 3 Year Insurance Companies Loss Info, or (C) Letter explaining all Property and Liability Loss for last 3 years.
Completed By
Title
Date
FAX
Phone
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