Latino Tax and Express Services Inc.

Named Insured *

Address Line 1

Address Line 2

City

State

ZIP

DBA

FEIN #

Phone *

Fax

Email *

Owned Property Since

# Years Experience

Policy Expiration Date

# Building Location

Description / Use

Location Address

Type of Construction

Aluminum
Artificial (Cultured) Stone
Barbed Wire
Barn
Brick
Brick and Block
Brick Veneer
Cement/Concrete Block
Concrete Block
Concrete Tilt-Up
Common (Solid) Brick
Earth Shelter
Fire Resistive/Superior
Frame
Granite/Stone
Greenhouse Wall
Joisted Masonry
Log
Manufactured Home / Mobile Home / Trailer
Masonry
Masonry Veneer
Modified Fire Resistive
Modular
Non-Combustible
Native Stone
Other
Painted Masonry
Plain Concrete
Plate Steel
Plywood
Pole
Poured Concrete
Precast Concrete
Precast Stone
PreEngineered Metal
Protected Steel Frame
PVC
Reinforced Concrete
Rail
Sheet Metal
Silo
Solid Brick
Solid Brick Cust
Slump Block
Superior Masonry Non-Combustive
Split Block
Split Rail
Solid Stone
Steel
Steel Frame
Stone and Block
Stone and Block Custom
Solid Stone Custom
Temporary Hardboard
Vinyl
Window Wall
Wood and/or Plaster Board
Woven Wire without Barbed Wire
Woven Wire with Barbed Wire
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Year built

Total SQ FT

# Units

# Fire Divisions

# Story

# Passenger Elevators

# Freight

# Separate Structures

Describe Other Structures

Resident Manager

Yes

# Yrs Experience

Property Manager

Yes

# Yrs Experience

On Site Property Manager / Office

Yes

Owner Lives On Site

Yes

Circuit Breakers

Yes

Smoke Detectors

Yes

Is Building In A Gated Community or Have Security Gates?

Yes

If Yes, Describe

Is The Building Designed For Its Current Type Of Operations?

Yes

Was Any Building Converted From A Different Type Of Occupancy?

Yes

If Yes, Describe

Any Wood Burning Stoves?

Yes

Any Charcoal Barbecues Used On Wood Decks, Patios Or Balconies?

Yes

Are All Exterior Doors Equipped With Deadbolt Locks?

Yes

Is There A Change Locks Procedure?

Yes

Hard Wired

Yes

Carbon Monoxide Detectors

Yes

Fire Extinguishers. If Yes, how many?

Tagged / Up-to-date

Yes

Interior Hallways / Stairs?

Yes

If Yes, Fire Doors

Yes

Auto-Closing Doors

Yes

Does The Building Have Standpipes On Each Floor?

Yes

If Yes, how many each floor?

If Interior Hallways, Are There Approved And Posted Evacuation Plans?

Yes

Railings Less Than 4 inches (If over 4″)

Yes

If Yes, Willing To Modify

Yes

Any Non-Releasable Window Bars?

Yes

If Yes, Will They Be Removed

Yes

Fire Alarms

Yes

Central Station / Monitored

Yes

Any Burglar Alarms or Monitored Security?

Yes

If Yes, Describe

Building Sprinklers. If Yes

Garage Areas If Yes

Building Sprinklers Inspected in Last 5 Years?

Yes

If Yes, Date

Building Sprinklers Regularly Monitored / Maintained

Yes

If Yes, Describe

Building Sprinklers — Is there A Current Sprinkler Certificate?

Yes

# Pools - If Yes

# Spas - If Yes

Pools / Spas Fenced

Yes

Fence Over 5ft

Yes

Pool / Spa: Is there a self-closing, self-locking gate?

Yes

Any Diving Board or Slides?

Yes

Is Depth Of Pool Marked And Pool Rules Posted?

Yes

Are Safety Rules Posted And Life Saving Apparatus Available?

Yes

Are All Pools / Spas Equipped With Anti-entrapment Device And/Or System For Drain Cover?

Yes

Are There Armed Guards On The Premises?

Yes

Is There a Written Safety Plan?

Yes

How often is property inspected. If Yes

Are There Any Signs Of Pre-Existing Or Water Damage To the Building?

Yes

If Yes, Describe

Any Roads Maintained or Owned?

Yes

If Yes, Describe

Any Recreation Rooms?

Yes

If Yes, Describe

Any Tennis, Racquet, Or Other Courts?

Yes

If Yes, Describe

Any Playgrounds?

Yes

If Yes, Describe

Any Saunas or Steam Rooms?

Yes

If Yes, Describe

Any Ponds, Lakes, or Streams?

Yes

If Yes, Describe

Any Greenbelts or Parks?

Yes

If Yes, Describe

Does The Property Have Marina Docks Or Lakefront?

Yes

If Yes, Describe

Is There Any Timeshare Or Short Term Rentals?

Yes

If Yes, Describe

If Habitational, Are There Any Risks That Are Not Habitational?

Yes

If Yes, Describe

Employee Training

Yes

Employee Screening

Yes

Any Uncompleted Recommendations?

Yes

If Yes, Describe

Wiring Updated

Any Aluminum

Yes

Plumbing Updated

Plumbing Type

Cast Iron
Copper
Other
PVC
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Roof Replaced

Roof Type

Aluminum Shingles
Architectural Shingles
Asbestos
Asphalt Shingle
Built Up without Gravel
Cedar Shakes
Cedar Shingles
Clay Tile or Slate
Composition (Fiberglass, Asphalt, etc.)
Concrete Tile
Concrete (Not Tile)
Reinforced Concrete
Copper
Fiberglass
Foam
Gravel
Light Metal Panel
Single Ply Membrane Ballasted
Metal
Mineral Fiber
Mission Tile
New England Pine Shingle
Other
Plastic
Plywood
Poured
Recycled Roofing Products
Rock
Rolled Roofing
Rubber Roof
Seam Metal
Slate
Single Ply Membrane Systems
Spanish Tile
Corrugated Steel
Steel/Porcelain Shingles
Tar and Gravel
Tar and Gravel (Built-up)
Tile
Tin
Unknown
Victorian Scalloped Shake
Wood Fiber Shingles
Wood Shakes
Wood Shingles
Wood Shake/Shingle
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Heating Updated

Last Painted

Renovation

Describe All Renovations

Driveways, Parkways Free Of Excessive Oil / Grease Buildup

Yes

All Walk / Park Surfaces Smooth And Even? (No Potholes Or Tripping Cracks On Surface)

Yes

Any Graffiti On Any Part Of The Building?

Yes

Any Abandoned Vehicles On The Property?

Yes

Trees & Shrubs Trimmed Away From Building

Yes

Landscaping Maintained

Yes

Overall Rating Of Property

Poor
Below Average
Average
Very Good
Excellent
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Present Insurance Carrier

Is Carrier Offering Renewal

Yes

If No, Why? Explain

Policy Number

Expiration Date

How Long With This Carrier

If Less Than 5 Years, List All Prior Carriers & Policy Numbers On Next Step.

< 1 Year
1-2 Years
2-3 Years
3-4 Years
4-5 Years
> 5 Years
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Are Loss Runs On File?

Yes

Date Requested

Any Claim for Sexual Abuse / Molestation?

Yes

If Yes, Describe

# Claims

Carrier Name

Policy Number

Date Of Loss

Description Of Loss

Amount Paid

Amount Reserved

Claim

Open
Closed
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Building Coverage Limits

Blanket Coverage

Yes

Valuation

ACV
RC
ERC
GRC
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Business Property Limits

Rental / Income / Fees Limits

General Liability Limits

Umbrella / Excess Liability

Yes

Premium

Carrier Credits / Discounts

Remarks / Notes

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