Is any property held in a trust? ___ Yes ___ No
If yes, answer the following:
Trust Name: _________________________________________________________________
Trustee(s): ___________________________________________________________________
Property: ____________________________________________________________________
Is the residence a historical landmark or showcase home? ___ Yes ___ No
If yes, answer the following:
Are tours conducted? ___ Yes ___ No
How many tourists visit annually? _______
What is the maximum number of visitors on a single day? _______
Is the property used for community activities? ___ Yes ___ No
If yes, answer the following:
Describe the activities.
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How often is the property used for this purpose? _________
What is the maximum number of visitors who might attend? _______
Does the applicant belong to a homeowners or condominium owners association? ___ Yes ___ No
If yes, attach a copy of the Association agreement and bylaws.
Is the residence located in a flood plain? ___ Yes ___ No
If yes, does the applicant carry flood insurance? ___ Yes ___ No
Is the residence located in a known earthquake area? ___ Yes ___ No
If yes, does the applicant carry earthquake insurance? ___ Yes ___ No
Does the applicant carry firearms or have firearms in the residence? ___ Yes ___ No
If yes, complete the firearms supplement.
Have there been any water-related (including backup of sewers or drains) losses? ___ Yes ___ No
If yes, answer the following:
List items damaged by water that remain in the residence.
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Is there any evidence of water leaking or seeping in the residence? ___ Yes ___ No
Are there odors in the residence that could suggest the presence of mold? ___ Yes ___ No
Are underground or above ground storage tanks on the premises? ___ Yes ___ No
Are flammables, chemicals, or fuel stored on the premises? ___ Yes ___ No
If yes, describe the property stored, where it is stored, and procedures to prevent ignition.
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Is lead paint in the residence? ___ Yes ___ No
Are chemicals sprayed on the premises? ___ Yes ___ No
If yes, describe is the chemical(s) sprayed and state whether the applicant or contractor does the spraying.
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Does the applicant own, lease, or rent additional residences? ___ Yes ___ No
If yes, prepare a separate questionnaire for each residence.
Does the applicant own rental property? ___ Yes ___ No
If yes, prepare a questionnaire for rental property.
