LOCATION QUESTIONNAIRE - California State University
PROPERTY INSURANCE
NEW LOCATION QUESTIONNAIRE
(To be completed by the Facilities Engineer, or other knowledgeable person, for each new location.)
I. GENERAL INFORMATION:
Location Address:
Local Contact:
Telephone Number:
Desired Date for Coverage to be Effective:
II. CONSTRUCTION INFORMATION:
Year Built: Number of Stories: Owner:
Construction:
(Exterior Walls, Structural Elements and Roof)
Square Footage: ___________ Lot Size: __________
III. OCCUPANCY: Please check all that apply.
Administrative Office Sales Office Distribution Center
Manufacturing Facility Leased Owned
Other (Please describe):
IV. FIRE PROTECTION: Check availability of Fire Protection Features.
Fire Extinguishers: Yes No Automatic Sprinkler: Yes No
Fire Hose: Yes No Waterflow Alarm: Yes No
Fire Hydrants: Yes No No. within 500 feet:
Heat or Smoke Detection: Yes No Local Central Station
Fire Department Response: Paid (full-time) Volunteer None Distance: miles
Describe any other fire protection features (such as a large body of water nearby, that can be used by Fire Department pumpers, etc.):
V. EXPOSURE:
(Distance from adjacent buildings/exposures and/or other tenants.)
VI. TOTAL INSURABLE VALUES: (Inventory at Selling Price, all other property at Replacement Cost):
Building (excl. Land): Leasehold Improvements:
Contents incl. Machinery & Equipment, Furniture/Fixtures:
Inventory: Business Interruption:
Please return this form to:
Alliant Insurance Services, Inc.
100 Pine Street, 11th Floor
San Francisco, CA 94111
Email: vrin@ / Fax: (415) 874-4810
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