P.O. Box 14770, Scottsdale, AZ 85267-4770
8475 E. Hartford Dr., Scottsdale, AZ 85255
(480) 991-7889 WATS (800) 848-8860
Fax (480) 948-1394 Toll Free (866) 240-8807
P.O. Box 571770, Murray, UT 84157-1770
5373 S. Green St., Suite 525, Murray, UT 84123
(801) 290-1144 WATS (800) 594-8900
Fax (801) 290-1160 Toll Free (800) 332-9285
PROTECTION CLASS QUESTIONNAIRE
(8B, 9, 10 or any Split Protection Class containing X,Y or W)
Named Insured:
Location Address:
1. Protection Class:
2. Central Station Fire and Burglar alarm system installed and monitored? ................................................... Yes No
3. Name and Address of responding Fire Department:
a. Does the Fire Department use paid employees, volunteers or both? .......................
Paid Volunteer Both
b. Response Time in minutes: Distance to Fire Station in miles (attach internet drive time map):
c. Number of pumpers: Tank Capacity (gallons): Pump Capacity (gallons per minute):
d. Number of tankers: Tank Capacity (gallons): Pump Capacity (gallons per minute):
4. Are roads paved and accessible year-round? ............................................................................................. Yes No
5. Is risk located in an area prone to road washout? .......................................................................................
Yes No
If yes, please explain:
6. Any physical barriers? ................................................................................................................................. Yes No
If yes, please explain:
7. If gated community, does Fire Department have access to gate security code? ................ Yes No Not Gated
8. Does property currently have at least two hundred (200) feet of brush clearance? ...................................
Yes No
9. Does risk have a Wood Shake Roof?..........................................................................................................
Yes No
10. Primary Heat Source:
11. Is there a public hydrant within 1,000 feet from the dwelling? .................................................................... Yes No
If no, describe the water source:
Distance from dwelling:
Is hydrant or water source accessible by the Fire Department year-round? ............................................... Yes No
If no, please explain:
12. Please explain any full-time or live-in employees:
13. Please explain if dwelling is not occupied year-round:
14. Is dwelling visible to full-time neighbors? .................................................................................................... Yes No
Comments:
