Special Attention

Acct # /
800.423.7099

Date:
Insured:
Address:
Policy # / ** / Date Inspected: / ID

SPECIAL ATTENTION

None

OCCUPANCY

/ Person interviewed / Title
Insured is a: / Corporation / Partnership / Individual.
Insured is the Bldg.: / Owner / Tenant / At this Location for the past / Years.
Insured Occupies: / All / None -Absentee Landlord / Part - Describe:
NA / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
Open: / OpenClosed N/A / OpenClosed N/A / OpenClosed N/A / OpenClosed N/A / OpenClosed N/A / OpenClosed N/A / OpenClosed N/A
Hours:

OPERATION/ HABITATION

PRODUCTS

/ None
Professional / Food Handler / Other
OFF- SITE OPERATIONS / None
Sales / Installation / Warehouse / Deliveries / Repairs / Surveys/ Inspections
Other:

ADDITIONAL LOCATIONS

None

RECOMMENDATIONS

None Noted

Fire Physical

Occupancy /

Insured is:

Owner/ Occupied

Owner/ Absentee landlord

Tenant

USE

Percent Used by Insured

BASEMENT:

FIRST FLOOR:

SECOND FLOOR:

THIRD FLOOR:

FOURTH FLOOR:

OTHER:

Outbuildings or Appurtenant Structures? Non e

CONSTRUCTION

EXTERIOR

Foundation: / Slab / Crawl Space / Basement
Exterior Walls: / Frame / Block / Brick / Other:
Roof: / Pitched: / Asphalt/ Composition / Other:
Flat: / Rubberized / Tar & Gravel / Not Seen
Age of Building: / No. Stories:
Overall Condition? / Good / Average / Improvement Needed

INTERIOR

Ceiling: / Drywall / Plaster / Tin / Drop Tile / Other:
Walls: / Drywall / Plaster / Panel / Other:
Floors: / Carpet / Resilient / Hardwood / Tile / Other:
Horizontal Cutoffs: / Exterior Doors / Exterior Windows / Interior Walls
Standard Doors / Stationary Windows / Firewall with Parapet
Self Closing Doors / Standard Windows / Block Wall/ Fire Partition – No Parapet
Fire Rated Doors / Skylights: _ / Fire Rated (Double) Sheet Rock
Other: / Standard Walls – Not Fire Rated
Vertical Cutoffs: / None / Enclosed Stairwells w/ self closing doors / Open Stairwells / Dumb Waiter
Garbage Chute / Elevator / Other:
Overall Condition? / Good / Average / Improvement Needed
Any Concealed Spaces? / None Noted / Above Drop Tile Ceiling / Attic
Soffits / Other:
PML (Probable Maximum Loss) = 100% / or PML =%- Less than100% - state why!
REMARKS:
HEATING, ELECTRIC, PLUMBING
Heating Fuel: / City Gas / Propane Gas / Electric Heat / Other:
Oil, if so /  / In-Ground Oil Tank / Basement Oil Tank / Outside Oil Tank
Heating Type: / BBHW / FHA / Steam / Other:
Air Conditioning: / Central Unit / Central Unit - Roof / Window or Wall Units / None
Furnace Location: / Ceiling Mounted / Basement / Vented Utility Room / Other:
Furnace Condition: / Good / Average / Improvement Needed
Electric: / Voltage: / Amperage:
Circuit Breakers / Fuses / Cartridges
Other:
Overall Condition: / Good / Average / Improvement Needed
Plumbing: / Copper % / PVC % / Galvanized % / Brass %
Plumbing Condition: / Good / Average / Improvement Needed
Sump Pump: / No / Yes - state why
PROTECTON
Fire Station: / 0-1 mile / 1-3 miles / 3- 5 miles / none
Fire Hydrant: / 0 - 500 feet / 500 - 1000 feet / > 1000 feet / None
Other Water: / Pump Trucks / Ponds/ Pools / Other / None
Bldg. Sprinklered: / No / Yes- / Wet System / Dry System / Auto / Manual

Standpipe Hoses:

/ No / Yes - describe
Fire Alarms: / None / Automatic / Manual / Other
Smoke Detectors: / None / Hardwired / Battery Operated / Other
Fire Extinguishers: / # / ABC / Dry Chem. / Tag Date: / None
EXPOSURES / Area: / Residential % / Mercantile % / Industrial %
Urban / Suburban / Rural
Distance / Construction / Use
Left / Ft
Right / Ft
Rear / Ft

Any Vacant Bldg. In Area

/ No / Yes
Any Graffiti in Area? / No / Yes
Any Other Noted Area Hazards? / No / Yes
REMARKS

Liability Physical

Insured / Use
Absentee Landlord
Owner Occupied
Tenant:
Building Use

Occupancy/ Area

Habitational:
Industrial/ Warehouse
Retail – Open to the Public
Office:
Habitational
None
Number of Families/ Apartments /

Remarks

Two Means of Egress from Each Apartment? / Yes / No
Common Doors Kept Locked? / Yes / No
Hardwired Smoke Detectors in Common Areas? / Yes / No
Battery Smoke Detectors in Apartments? / Yes / No
EXTERIOR / u / s / N/A / u / s / N/A
Exterior Walks / Balconies / None
Surfaces are Level / Flat Surfaces
Free of Cracks And/or Bulges / Non-Slip Surfaces
Properly Pitched / Proper Guardrails
Free of Debris / Balusters (5"oc or less)
No standing Water/ Ice Potential / Properly Illuminated
Properly Illuminated
Exterior Stairs / None / Ramps / None
Uniform Tread & Rise w/i code / Est. Slope 4-15 Degrees
Handrails Provided
(4 or more steps) / Hand Rails Provided
(33-34" high)
No Winding/ Circular Stairs / Ramps min 36" wide
Good Condition / Flat Surfaces
Free of Debris / Non-slip Surface
Doors Do Not Open onto Stairs
(should open onto a landing) / Landings Provided at Exit,
Entrance & Turning Areas
Properly Illuminated
Parking Lots / None / Dumpsters / None
Smooth & Free of Potholes / Enclosed
Paved / Not on Wheels
Lined Parking Spaces / Chained/ Locked
Wheel Stops/ Bumper Guards / Good Condition
Handicapped Parking
Speed Bumps / Playgrounds or Pools / None
Fire Lanes at Egress / Private Use Only
Properly Illuminated / Condition Good
Safe Access onto Road / Fenced and Locked

Key

/ Guards Hours Posted
u = unsatisfactory / s = satisfactory / N/A = NON APPLICABLE / Properly Illuminated
INTERIOR / Indoor Walkways / U / S / N/A / Exits/ Egress / U / S / N/A
Adequate Aisle Space / Lit Exit Signs (w/i 75ft)
Flat Surfaces / Emergency Lighting (w/i 75 ft)
Non-Slip Surfaces / Doors Open Outwardly (onto a level surface)
Carpets Fastened/ Secured / Panic Hardware
Mats on Marble/ Terrazzo Floors / Good Condition
Surfaces Free of Debris / Automatic Doors (in Working Order)
Properly Illuminated / Good Condition
DIAGRAM / Diagram Attached/ Unloaded
Diagram Notes:
INSURED'S AREA
Sq Feet
Basement
1st Fl
2nd Fl
3rd Fl

KEY

B = Basement / C/S = Crawl Space / WOD = Wood Deck / GAT = Attached Garage
U/B = Unfinished Basement / C/C = Cathedral Ceiling / WBA = Wood Balcony / GBU = Built-in Garage
F/B = Finished Basement / OP = Open Porch / OB = Open Breezeway / BGF = Basement Garage
SLA = Slab on Ground / EP = Enclosed Porch / EB = Enclosed Breezeway / CPT = Carport
OS = Open Stairway / ES = Enclosed Stairway / F.E. = Fire Escape / E = Elevator
ADJ = Adjacent Structure / ATT = Attached Structure (Common Wall) / FW = Firewall w/ Parapet

/ Insured Is The Landlord And Does Not Occupy Space Here
Location/ Description/ Concentration / Est. Value / Peak Season Value
Improvements & Betterments
Premises (Tenants Only)
Office Equipment/ Furniture
Computers Electronics
Machinery
Stock – General Merchandise
Stock – Perishable
Target Stock? Describe
Drugs or Medical Equipment
Other:
Burglary Protection / Insured Is the Landlord and Does Not Occupy Space Here
Alarms / None / Insured did not wish to disclose
Rings at: / Central Station / Insured’s Home
Police Department / Other:
Local Gong
Activated by: / Perimeter system (tape or contacts on doors and windows)
Motion Detectors (electron eyes) / Video Monitored
Heat Detectors or Infrared Detectors / Other:
Company that Installed System / Not Avail or Not Known
Company Servicing this System / Not Avail or Not Known

Locks

Doors: / Single Spring / Single Dead / Panic Bar
Double Spring / Double Dead / Other:
Windows: / Stationary / Cam Locks
Bars / Other:
Skylights: / Stationary / Other:
Other Openings:
Fire Escapes / None / Accessible from the Ground / Not Readily Accessible
Banking Practices / - Not Applicable
Daily / Weekly / Other:
Cash / % / Checks / % / Other / %
Any Cash taken home? / No / Yes / $
Any Cash left overnight? / No / Yes / $
Safe on Premises? / No / Yes / Describe / Fire Rated? / Yes No
Area/ Neighborhood
Area: / Urban / Suburban / Rural
Industrial / % / Mercantile / % / Residential / %

Crime Rate:

Considered: / High / High/ Moderate / Moderate / Moderate/ Low / Low
Any Signs of Graffiti or VMM? / No / Yes – describe or photo
Vacant or Boarded Bldg. in the Area? / No / Yes – describe or photo
Police Patrol Area? / No / Yes - / Foot Patrol / Bike Patrol / Squad Car

Note

Conclusions are not to be drawn that there are no other hazards or unsafe conditions. Also we do not imply that all Federal, State or other political subdivision Safety Standards and/ or Regulations have been met. Furthermore, we cannot assume any responsibility or legal liability from misinformation given our representative or for any consequential damages resulting from inaccuracies, human error or delays, for whatever reason in reporting unusual conditions to you.

Report made from observation and interview and concerns such conditions and practices as were observed and considered at the time of call. It is not intended to indicate that there are no other exposures. We do not assume a legal liability due to misinformation given by the inspector, nor inaccuracies or human error. Answers to questions and narrative remarks based only on statements of informants available at time of inquiry and not on public records, searches, verifications, etc., unless where specifically otherwise stated in answers or remarks.

BOP.doc Last Updated: 3/28/2012 11:38:00 AM

Special Attention