CHUBB ACORD SUPPLEMENT
Clients Information
For retired clients provide the occupation prior to retirement:
Clients email if available:
For entities other than an individual (LLC/Corp/LTD) confirm if they engage in business and/or own
business or commercial property under the entity name:
Dwelling Information
Prior/Current Carrier:
If Fireman’s Fund/Ace or Chubb provide reason applicant is shopping:
If yes provide details:
Dwelling under construction: Yes No
Retrofitted: Yes No
Year retrofitted:
1 ft. – 499 ft. 500 ft. – 999 ft.
Distance to brush: Within Brush
2500 ft. - 4999 ft. +5000 ft.
Roof shape: flat Gable Gambrel Hip Mansard Shed
Roof covering: Asphalt
1000 ft. – 2499 ft.
Other
Tile Wood Shake/Shingle
Other
Credits Available – check all that apply
Fire Hydrant Within 1000 Feet
Fire Station Within 5 Miles
Central Station Burglar Alarm
Central Station Fire Alarm
Residential Sprinkler System Gated Community Gated Community Patrol
Service Superior Credits Available – check all that apply
Water Flow Alarm
Temperature Monitor
24-Hour Security Full Time Caretaker
Backup Generator
Gas Leak Detector
Seismic Shut Off Valve
Lighting Protection
Water Leak Detection Alarm
Gated House Manual Wildfire Suppression System
Automatic Wildfire Suppression System
