Fillable CONDOMINIUM/HOMEOWNERS ASSOCIATION SUPPLEMENT APPLICATION (Risk Placement Services, Inc.)

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CONDOMINIUM/HOMEOWNERS ASSOCIATION SUPPLEMENT APPLICATION (Risk Placement Services, Inc.)

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8700 EAST NORTHSIGHT BLVD., SUITE #200 • SCOTTSDALE, ARIZONA • 85260-3669 PHONE 800-243-1782 • FAX 480-951-9722
Applicant’s Name: _________________________ Location Address: _________________________
Mailing Address: _________________________ _________________________
_________________________ _________________________
Condo/Townhome Association Single Family Dwellings Timeshare No. of Units: __________
Does developer retain any interest in the association? Yes No
List percentage of owner operated units: ___________%
List percentage of commercially owned/operated units: ___________%
Any of the following? Please describe all “yes” answers in detail below.
Baseball Fields
Yes No
Clubhouse
Yes No
Restaurants
Yes No
Basketball Courts
Yes No
Convenience Stores
Yes No
Saunas/Spas
Yes No
Racquetball Courts
Yes No
Dams/Reservoirs
Yes No
Security Guards
Yes No
Tennis/Volleyball
Courts
Yes No
Lakes
Yes No
Sewage Treatment
Plants
Yes No
Bathing Beaches
Yes No
Lifeguards
Yes No
Special Events
Yes No
Bike/Horse Trails
Yes No
Parks
Yes No
Stables/Riding
Arenas/Jumps
Yes No
Boat Docks/Slips
Yes No
Playgrounds
Yes No
Streets/Roads
# of miles _______
Yes No
Waterworks
Yes No
Details:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Are there other exposures the association is responsible for? Yes No
If yes, please detail: __________________________________________________________________
___________________________________________________________________________________
Do they provide any common area for individual associations? Yes No
SWIMMING POOL INFORMATION CHECK HERE IF NOT APPLICABLE
Number of pools __________
Are pools fenced from all units? Yes No
If yes, what is the height of the fence? __________ Self-closing gate? Yes No
CONDOMINIUM/HOMEOWNER’S ASSOCIATION
SUPPLEMENT APPLICATION
(Include Acord application)
8700 EAST NORTHSIGHT BLVD., SUITE #200 • SCOTTSDALE, ARIZONA • 85260-3669 PHONE 800-243-1782 • FAX 480-951-9722
Any structures within 10 feet of edge of pool? Yes No
Is there a diving board or slide? Yes No
If yes, what is the height of the board? __________ Depth markers? Yes No
Shepard’s hook/ring nearby? Yes No
Please detail all “yes” answers to the questions above, including any claims:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance containing false information, or conceals for the purpose of misleading, information
concerning any fact material thereto, commits a fraudulent insurance act, which is a crime. This application
does not bind any of the parties to complete the insurance transaction.
____________________________________ ______________________________ _________
Applicant’s Signature Producer’s Signature Date
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CONDOMINIUMHOMEOWNERS ASSOCIATION SUPPLEMENT APPLICATION (Risk Placement Services, Inc.)

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Completed 30 July 2020

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