Evidence of Property Coverage Request

Location Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Building Coverage Required?
- Yes
- No
Amount desired/needed
Business Personal Property Needed?
- Yes
- No
Amount desired/needed
Improvements and Betterments Coverage Required?
- Yes
- No
Amount desired/needed
Year Built
Type of Construction
(ex: Frame, Joisted Masonry, Non-Combustible, Masonry Non-Combustible, etc)
Square Footage of Suite
Square Footage of Entire Building
Monitored Alarm?
- Yes
- No
Sprinklered?
- Yes
- No
Roof type
(Flat, Gravel, Metal, Tar, Asphalt, etc.)
Roof improvements if 20 years or older?
- Yes
- No
What year?
HVAC Improvements?
- Yes
- No
What year?
Electrical Improvements?
- Yes
- No
What year?
Plumbing Improvements?
- Yes
- No
What year?
Property Management Contact Info
Property Management Company Name
Property Management Company Email
Property Management Company Phone #
Landlord Contact Info
Landlord Name
Landlord Email
Landlord Phone #
Mortgage Contact Info
Mortgage Contact Name
Mortgage Contact Email
Mortgage Contact Phone #
Loan #
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Email
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