Hotel/Motel

Personal Information
First Name Required Input Required
Last Name Required Input Required
Street Required Input Required
City Required Input Required
State Required Input Required	select AL AK AZ AR CA CO CT DE FL GA HI ID IA IL IN KS KY LA ME MD MA MI MN MS MO MT NC ND NE NV NH NJ NM NY OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY
ZIP / Postal Code Required Input Required Please enter a valid Postal code.
Primary Phone Number Required Input Required Please enter a valid phone number
E-Mail Address Required You must provide an e-mail address. A valid e-mail address is required.
Ownership
Applicant Required Undefined
SS# of Owner Required Undefined
Number years owned this risk Required Number years owned this risk is required.
Number years in Motel/Hotel business Required Number years in Motel/Hotel business is required.
Has owner been involved now or ever in any Bankruptcies? Required Has owner been involved now or ever in any Bankruptcies? is required.	Yes No
Has owner been involved now or ever in any Foreclosures? Required Has owner been involved now or ever in any Foreclosures? is required.	Yes No
Has owner been involved now or ever in any Tax Liens? Required Has owner been involved now or ever in any Tax Liens? is required.	Yes No
Has owner ever been involved now or ever in any Business Failures? Required Undefined	Yes No
Has owner ever been involved now or ever in any Litigation? Required Undefined	Yes No
Is manager/owner on premises 24/7? Required Is manager/owner on premises 24/7? is required.	Yes No
Does owner do employee background checks? Required Does owner do employee background checks? is required.	Yes No
Number of Employees Required Number of Employees is required.
Is there a program in affect to provide safety to guests? Required Is there a program in affect to provide safety to guests? is required.	Yes No
Is there a program in affect for pool maintenance? Required Undefined	Yes No
Beds, Cribs, Appliances? Required Undefined	Yes No
General
Is the risk open year round? Required Undefined	Yes No
If no, explain: Optional
Any rentals monthly? Required Undefined	Yes No
Any rentals hourly? Required Undefined	Yes No
Any rentals to government, municapal sponsored, welfare housing programs? Required Undefined	Yes No
Any rentals to colleges for dormitory residences? Required Undefined	Yes No
Or other simlar type rentals? Required Undefined	Yes No
Total units: Required Undefined
Average room rates: $ Required Undefined
Occupancy rate: Required Undefined
Security
What, if any, security is present at facility? Guards? Required Undefined
Armed? Required Undefined
Are they contracted? Required Undefined
What type of locks are on guest rooms? Required What type of locks are on guest rooms? is required.	select Electronic Standard
Do keys have room numbers on them? Required Undefined	Yes No
Are security cameras installed? Required Undefined	Yes No
How does risk control access to guest keys? Required Undefined
Are there written guidelines provided to staff on risk's security measures? Required Undefined	Yes No
Do rooms have peepholes? Required Undefined	Yes No
Do rooms open to outside or to inside hallway? Required Undefined	select Outside Inside hallway
Property
Construction: Required Construction: is required.	select Frame Masonry Non Combustible Masonry N/C Fire Resistant
Number of Buildings: Required Undefined
Number of total units: Required Undefined
Numbers of units in each building: Required Undefined
Stories of each building: Required Undefined
Is risk 100% sprinkled? Required Undefined	Yes No
Distance from ocean, gulf or bay? Required Undefined
Updates to Roofing? Required Undefined	Yes No
Updates to Wiring? Required Undefined	Yes No
Updates to Heating? Required Undefined	Yes No
Updates to Plumbing? Required Undefined	Yes No
Please give dates to any of the above updates. Required Undefined
Any aluminum wiring? Required Undefined	Yes No
Is cooking permitted in any rooms, i.e. Kitchenettes? Required Undefined	Yes No
Types of alarms: Required Undefined	Central Station Fire Burglary Other None
General Liability
Swimming Pools? Required Undefined	Yes No
How many? Required Undefined
Indoors or outdoors? Required Undefined	select Indoor Outdoors Both
Are they fenced? Required Undefined	Yes No
Are pool rules displayed? Required Undefined	Yes No
Any diving boards or slides? Required Undefined	select Diving Boards Slides Both Neither
Is safety equipment (i.e. life preservers) available at poolside? Required Undefined	Yes No
Are depths marked clearly for all to see? Required Undefined	Yes No
Are there any hazardous recreational activities such as: Required Undefined	Playgrounds Fitness Centers Boating Other?
Do bathtubs have non slip surfaces? Required Undefined	Yes No
Any of the following?: Required Undefined	Daycare facilities Mercantile facilities Banquet facilities Convention facilities
If you have a banquet facility, how many events per year? Required Undefined
Are COI's obtained by insured if outside contractors are used? Required Undefined	Yes No
Are rooms equipped with smoke detectors? Required Undefined	Yes No
If so, are they hardwired? Required Undefined	Yes No
Are there mercantile facilities on premises? Required Undefined	Yes No
Are they leased out? Required Undefined
Are COI's obtained? Required Undefined
Does insured have a commercial auto policy? If so, NOA/HC must go on the CA policy. Required Undefined	Yes No
Any elevators? Required Undefined	Yes No
Are inspections up to date? Required Undefined	Yes No
Any Night Clubs or Lounges on premises? Required Undefined	Yes No
Enter Validation Code Required

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