OPERATIONS/ OCCUPANCY



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|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 |

|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 |

|Occup|Insured is: | Owner/ Occupied | Owner/ Absentee landlord | Tenant | |

|ancy | | | | | |

| | |USE |Percent Used by |

| | | |Insured |

| |BASEMENT: |      |- |     % |

| |FIRST FLOOR: |      |- |     % |

| |SECOND FLOOR: |      |- |     % |

| |THIRD FLOOR: |      |- |     % |

| |FOURTH FLOOR: |      |- |     % |

| |OTHER: |      |- |     % |

| |Outbuildings or Appurtenant Structures? Non e       | | |

| | |- |     % |

|CONST| |

|RUCTI| |

|ON | |

| | |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: |

| |Floors: | Carpet | Resilient | Hardwood |

| | |

| |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: |

| |      |

|HEATI| |

|NG, | |

|ELECT| |

|RIC, | |

|PLUMB| |

|ING | |

| |Heating Fuel: | City Gas | | Electric Heat | Other: |      |

| | | |Prop| | | |

| | | |ane | | | |

| | | |Gas | | | |

| |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 |

| | | | | | |

| | | Other: |      | |

| |Overall Condition: | Good | Average | Improvement Needed |

| |Plumbing: | Copper      % | PVC      % | Galvanized      % | Brass      % |

| |Plumbing Condition: | Good | Average | Improvement Needed |

| |Sump Pump: | No | Yes - state why       |

|PROTE| |

|CTON | |

| |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: |

| |Bldg. Sprinklered: | No | Yes- | Wet System |

| |Fire Alarms: | None | Automatic | Manual | Other |

| |Smoke Detectors: | None | Hardwired | Battery Operated | Other |

| | | |

| |Fire Extinguishers: |#       | ABC |Dry Chem. |Tag Date:       | None |

| | |

|EXPOS|Area: | Residential      % | Mercantile      % | Industrial      % |

|URES | | | | |

| | | 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: |      |

| | |

|Buildin| |

|g Use | |

| | |Occupancy/ Area |

| | Habitational: |      |

| | Industrial/ Warehouse |      |

| | Retail – Open to the Public |      |

| | Office: |      |

| | |

|Habitat| |

|ional | |

| | 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 |      |

| | | | | |

|EXTERIO| |u |s |

|R | | | |

| |Surfaces are Level |

| |Exterior Stairs | None |Ramps | None |

| |Uniform Tread & Rise w/i code |

| |Parking Lots | None |Dumpsters | None |

| |Smooth & Free of Potholes | | | | |

| |u = unsatisfactory |

|DIAGRAM| | Diagram Attached/ Unloaded |

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| | |Diagram Notes: |

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| | | |INSURED'S AREA | |

| | | | |Sq Feet | | |

| | | |Basement |      | | |

| | | |1st Fl |      | | |

| | | |2nd Fl |      | | |

| | | |3rd Fl |      | | |

| | | | |

|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 |

|Contents | Insured Is The Landlord And Does Not Occupy Space Here |

| | |Location/ Description/ Concentration |Est. Value |Peak Season Value |

| |Improvements & Betterments |      |[pi|      |[pi|      |

| |Premises (Tenants Only) | |c] | |c] | |

| |Office Equipment/ Furniture |      |[pi|      |[pi|      |

| | | |c] | |c] | |

| |Computers Electronics |      |[pi|      |[pi|      |

| | | |c] | |c] | |

| |Machinery |      |[pi|      |[pi|      |

| | | |c] | |c] | |

| |Stock – General Merchandise |      |[pi|      |[pi|      |

| | | |c] | |c] | |

| |Stock – Perishable |      |[pi|      |[pi|      |

| | | |c] | |c] | |

| |Target Stock? Describe |      |[pi|      |[pi|      |

| | | |c] | |c] | |

| |Drugs or Medical Equipment |      |[pi|      |[pi|      |

| | | |c] | |c] | |

| |Other: |      |[pi|      |[pi|      |

| | | |c] | |c] | |

| |

|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 |

| | | 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 |$ |      | |

| |

|Area/ Neighborhood | |

| |Area: | Urban | Suburban | Rural |

| |

| |Crime Rate: |

| | |Considered: |

| | |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 |

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