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Homeowners Association Questionnaire
Call Us Today
(703) 986-0468
Homeowners Association Questionnaire
Recent life changes can open up your eligibility for discounts or leave you inadequately covered. We can help you keep your insurance coverage up-to-date by conducting an insurance review. Please answer all questions. Thank you for your time!
Named Insured:
First
Middle
Last
Website:
Prohibited Circumstances
Does the applicant have it’s own volunteer fire department, sheriff, police or rescue squad?
Yes
No
Does the risk operate/maintain a sewage treatment facility or water treatment facility?
Yes
No
Does the applicant have a garbage dump?
Yes
No
Does the applicant have a private airport?
Yes
No
Does the applicant have an ice skating rink exposure?
Yes
No
Is the developer or contractor a named insured?
Yes
No
Does the applicant employ any security guards/patrol (independent contractors are ok)?
Yes
No
Does the applicant contract with armed security guards?
Yes
No
Does the applicant have a Class I or II dam (greater than 40 feet tall, have a storage Yes No volume greater than 500 acre feet or have a potential downstream hazard of injury or death to people, damage to homes, businesses, highways, railroads or other dams)?
Yes
No
Does the applicant allow time shares?
Yes
No
General Information
How many total units are in the association?
How many units in the association are still undeveloped?
Do you rent your club house to others?
Yes
No
What is the total area of the club house?
Does the risk have a water dam exposure?
Yes
No
What is the height of the dam?
What is the storage volume of the dam?
What is the downstream damage potential?
Other Exposures
1. Complete each of the following. Number of:
Athletic Fields or Courts
Swimming Pools
Whirlpools
Saunas
Lakes, Ponds, or Reservoirs
1. Complete each of the following. Number of:
Beaches
Boat Docks or Slips
Miles of Road Maintained by Applicant
Clubhouses
Parks or Playgrounds
Today's Date
*
MM slash DD slash YYYY
Signature
*
Phone
This field is for validation purposes and should be left unchanged.
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The Independent Agent Advantage
The Independent Agent Advantage
As Independent Agents, we are free to choose the best carrier for your insurance needs. We do not work for an insurance company; we work for you.
Simply put, we are here to make sure you get the most for your money by getting the best possible coverage for your individual insurance needs.
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