Supplemental Multi-Family Program Questionaire
Date: 
Please complete a separate questionaire for each location
 
Applicant: 
Location No.:  Producer: 
Address: 
 
City, State, Zip:    
 
Please answer each question. Explain all answers marked with an asterisk in detail on a separate sheet.
  YES NO
Are there smoke detectors in all living units?  *
Are there smoke detectors in all enclosed hallways and stairwells?  *
Are all tub/shower surfaces of a "non-skid" type?  *
Is all tub/shower door glass made with "safety glass?"  *
Are the premises fenced and is access restricted or controlled?  *
Are any rentals for other than a monthly basis (except motels)?  *
Are there any subsidized units and/or rental charges?  *
Are there any horizontal railings on balconies or walkways?  *
Are there any children's playgrounds on the premises?  *
Are there any exercise facilities on the premises?  *
Are all pools and spa completely fenced?  *
Are all pool gates equipped with self-closing/locking devices?  *
Are there any water slides or diving boards on the premises?  *
Is the pool depth clearly marked on the exterior of the pool?  *
Are there any saunas on the premises?
Are all saunas equipped with panic bars?  *
Is risk located within 500 feet of any river, lake or ocean?  *
Are there any lakes, streams, or ponds on the premises?  *
Are there any "wood shake" roofs?  *
Are all stairwells equipped with self-closing fire doors?  *
Is the insured responsible for any public streets or roads?  *
 
If property value is over $6,000,000, and if there is more than one building, a diagram is required.
 
COMPLETE FOR APARTMENTS:
Total number of units: Vacant units: Average Monthly rent: $
COMPLETE FOR CONDOMINIUMS:
Number of owner-occupied units: Total number of units:
 
 
Applicant Signature:__________________________________________________     Date: ___________
 
 
 
Producer Signature:__________________________________________________     Date: ___________

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