Fillable Self- Storage Facility & Supplemental Application (All Risks, Ltd)

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Self- Storage Facility & Supplemental Application (All Risks, Ltd)

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Self-Storage Facility Application 03.20 Page 1 of 5
ALL RISKS, LTD. – National Specialty Programs
10150 York Road, 5
th
Floor, Hunt Valley, MD 21030
Toll-Free: 800-366-5810
•
Fax: 410-828-8179
Contact us: programs@allrisks.com
•
www.allrisks.com
Self-Storage Facility Application
I. GENERAL INFORMATION
1. Name of Applicant: ________________________________________________ Requested Effective Date: ______________
DBA (if applicable): ________________________________________________ FEIN: _______________________________
Do you conduct business under any other name? Yes No
If yes, please list these names on a separate paper.
Insured Email Address: _________________________________________________________________________________
2. Physical Street Address: ________________________________________________________________________________
City/County/State/Zip Code _____________________________________________________________________________
3. Business Owner(s): ______________________________________________ Percentage(s) of Ownership: ________ %
______________________________________________ ________ %
4. Phone: ___________________________________ Fax: __________________________________________
Email: ___________________________________ Website: ______________________________________
5. Business Type: Individual Partnership Corporation Other (describe): _________________________
6. Number of years in business under the above name: __________
Additional years of Owner’s Self-Storage experience: __________
If applicable, please describe Owner’s prior Self-Storage experience: _____________________________________
_____________________________________________________________________________________________
Additional years of Manager’s Self-Storage experience: _________
If applicable, describe Manager’s prior Self-Storage experience: _________________________________________
_____________________________________________________________________________________________
II. BUSINESS ORGANIZATIONAL DATA (Please complete every item or indicate N/A)
1. Does the Applicant/Owner currently own any other entities or operate any other businesses? Yes No
If yes, please explain and verify that separate General Liability Insurance is in place for
these operations: _____________________________________________________________________________
2. Does the Applicant/Owner (applicant being the parent company) currently own any subsidiaries? Yes No
If yes, please explain and verify that separate General Liability Insurance is in place for
these operations: _____________________________________________________________________________
3. Is the Applicant/Owner currently listed as a Subsidiary of any other Company? Yes No
If yes, please explain and verify that separate General Liability Insurance is in place for
these operations: _____________________________________________________________________________
III. OPERATIONS (Please complete every item or indicate N/A)
1. Describe the Owner’s duties or involvement in the daily operations: ____________________________________________
____________________________________________________________________________________________________
2. Are you an active member of any State and/or National Trade Association (e.g. SSA, AMSA, etc)? Yes No
If yes, please list: ______________________________________________________________________________
3. Number of Full-Time Employees: ____________ Number of Part-Time Employees: ____________
4. Pre-Employment Screening for your employees includes which of the following (check all that apply):
Criminal Background Check Prior Employer Contacted Personal References Driving Record Check
Drug Screening Other (please describe): ________________________________________________
5. Do you have a Training Program in place for new Employees? Yes No
If yes, please describe your training program: _______________________________________________________
6. Is your Rental Office located at your facility? Yes No
Self-Storage Facility Application 03.20 Page 2 of 5
7. Does your Manager reside at your facility? Yes No
8. Do your Manager’s duties include daily lock checks? Yes No
9. Your Facility hours of operations: __________ to ___________ on the following days: ______________________________
10. Is your Facility accessible to your customers after hours? Yes No
11. Are two forms of identification required from each prospective Tenant in order to rent space? Yes No
12. Do you offer Customer Storage Insurance to all of your tenants? Yes No
If yes, through which insurance company? __________________________________________________________
13. If your tenants do not purchase Customer Storage Insurance from you, are they required to provide you with evidence of
in-force Customer Storage Insurance coverage? Yes No
14. Are all tenants required to sign your rental contract? Yes No
If yes, please attach a copy of your rental contract.
15. Are signs displayed throughout your facility that state that the storage of flammables, hazardous, or toxic materials and/or
any other pollutants is prohibited? Yes No
16. Do you comply with all applicable laws concerning the sale and disposal of tenant’s property? Yes No
17. Do you sell and/or rent padlocks, packing supplies and/or storage materials? Yes No
If yes, are your sales/rentals of these items limited to your tenants and/or on-site
retail customers? Yes No
18. Do you sell and/or rent (Retail, Wholesale and/or via the Internet) any other products? Yes No
If yes, please describe: __________________________________________________________________________
19. Do you and/or any of your Tenants conduct any type of non-storage operations(e.g. manufacturing, service, repair, etc.) at
your facility? Yes No
If yes, please describe these operations: ___________________________________________________________
20. Are forklifts and/or loaders used? Yes No
If yes, is this equipment operated only by you and/or your Employees? Yes No
21. Do you have a Maintenance Agreement in place for your Fire Suppression (Sprinkler) System? Yes No N/A
22. Do you use an Incident and/or Accident Reporting Form? Yes No
If yes, do you retain a copy of each completed form for a minimum of 5 years? Yes No
IV. SALES (Please complete every item or indicate N/A)
1. What is your current average occupancy rate? _____ % What was your average occupancy rate last year? _____ %
2. Please provide your total estimated Annual Gross Sales (FOR EACH APPLICABLE OPERATION LISTED BELOW)
Operation
Estimated Annual Gross Sales
Self-Storage Rental Units
$
Mailbox Rentals
$
Vault Rentals
$
Document/Record Storage/Management
$
Self-Storage Car Wash
$
Truck and/or Trailer Rentals
$
Propane Sales and/or Refilling
$
Container Storage
$
Pick-Up and/or Delivery of Mobile Storage Containers
$
Boat and/or Recreational Vehicle Storage
$
Boat and/or Recreational Vehicle Services and/or Maintenance (i.e. other than storage)
$
Fire Art, Antiques and/or Classic Automobile Storage
$
Wine Storage
$
Sales/Rental of Padlocks, Packing Supplies and/or Storage Materials
$
Other Product Sales/Rentals (i.e. other than padlocks, packing supplies, and/or storage materials)
$
Other (Please describe): __________________________________________________
$
Self-Storage Facility Application 03.20 Page 3 of 5
V. HIRED AUTO AND NON-OWNED AUTO LIABILITY (Please complete every item or indicate N/A)
1. If you are not interested in purchasing Hired Auto and Non-Owned Auto Liability coverage,
please check this box and skip to SECTION VI.
2. Do you currently have any Auto Insurance in place for your business operations? Yes No
If yes, through which insurance company? _________________________________________________________
3. Before allowing an employee to drive an Auto in connection with your business, do you verify that the
Employee has current Auto Insurance in place with Limits of Liability equal to or greater than $300,000? Yes No
If yes, how is this verified? ______________________________________________________________________
VI. PRIOR INSURANCE (Please complete every item or indicate N/A)
1. Please provide details about prior insurance coverage for the last 5 years:
Year
Insurance Carrier Name
Total Annual Sales
$
$
$
$
2. In the past 5 years, has your insurance been declined, canceled or non-renewed? Yes No
If yes, please explain why: _______________________________________________________________________
VII. CLAIMS HISTORY (Please complete every item or indicate N/A)
1. Please provide details about your claim history for the last 5 years – if none, please state “NONE”:
Date of Loss
Description of Loss
Open or Closed
Total Incurred
$
$
$
$
2. Are you aware of any incidents that have occurred prior to the date of this Application which could result
in a claim against you? Yes No
If yes, please provide details: _____________________________________________________________________
_____________________________________________________________________________________________
PLEASE ATTACH A COPY OF EACH OF THE FOLLOWING ITEMS:
5 YEAR, CURRENTLY VALUED INSURANCE CARRIER LOSS RUNS FOR EACH LINE OF COVERAGE
YOUR SELF-STORAGE RENTAL CONTRACT
PHOTOGRAPHS OF YOUR FACILITY
A PLOT PLAN OF YOUR FACILITY
Self-Storage Facility Application 03.20 Page 4 of 5
Self-Storage Facility Supplemental Application
1. Was each building at your facility originally designed for Self-Storage? Yes No
If no, please answer each of the following:
a. Which building and what was it originally designed for? ________________________________________
b. Has the building been updated in accordance with all governing construction codes? Yes No
c. What year was the building converted into a Self-Storage Facility? _______________
2. Number of Open Lot Rental Spaces: ____________ Number of Covered Parking Rental Spaces: ____________
3. Number of Car Wash Stalls: ____________
4. Please describe EACH building located at your facility:
Building 1
Building 2
Building 3
Building 4
Building 5
Occupancy Description (e.g. Storage
Units, Office, Garage, etc.)
Number of Rental Units
Building Age
Building Construction Type
(e.g. Frame, Joisted-Masonry,
Non-Combustible, Masonry
Non-Combustible, Modified Fire
Resistive, Fire Resistive)
Total Square Footage
Number of Stories
Distance to Closest Owned Building
Climate Controlled
Yes No
Yes No
Yes No
Yes No
Yes No
Operational Fire Suppression
(Sprinkler) System
Yes No
Yes No
Yes No
Yes No
Yes No
Operational Central Station
Fire Alarm
Yes No
Yes No
Yes No
Yes No
Yes No
Operational Local Fire Alarm
Yes No
Yes No
Yes No
Yes No
Yes No
Operational Central Station
Burglary Alarm
Yes No
Yes No
Yes No
Yes No
Yes No
Operational Local Burglary Alarm
Yes No
Yes No
Yes No
Yes No
Yes No
Lightning Arrestor System
Yes No
Yes No
Yes No
Yes No
Yes No
5. If any building listed above is over 25 years old, please provide the date of the most recent updates:
Date of Most Recent Update:
Building 1
Building 2
Building 3
Building 4
Building 5
Electrical
Plumbing
Heating
Roofing
6. What type of additional security is provided at your facility (please check all that apply)?
Video surveillance/monitoring Controlled gate access system Keyboard touch pad or card entry
Visitor sign-in and sign-out Armed Security Guard(s) Unarmed Security Guard(s)
Fully fenced (chain-link, min height 6ft) Fully lighted at night Gates locked at night
Gates visible from Manager’s office Individual door alarms Tenants provide own locks
Duplicate keys retained on site Guard dog(s) Other (describe): __________________
7. Video Surveillance:
Is the entire facility monitored by video cameras? Yes No
Is the entire perimeter of each building monitored by video cameras? Yes No
Is each gate to the facility monitored by video cameras? Yes No
Self-Storage Facility Application 03.20 Page 5 of 5
How long is the video archived? ______________________________________
8. Please list your desired limits for all desired coverages for each applicable building located at your facility:
Building 1
Building 2
Building 3
Building 4
Building 5
Building (at replacement cost)
Business Personal Property
9. Please confirm the annual revenue and occupancy rates for the past three policy terms:
Expiring Term
1
st
Year Prior
2
nd
Year Prior
Occupancy Rate
Annual Revenue
Do you or any affiliated entities:
a. Have any prior or current bankruptcy or receivership activity against you? Yes No
b. Have any open tax liens or judgments pending? Yes No
c. Have any outstanding collection items or trade payments issues? Yes No
10. Do you own any other building (i.e. not listed on any of our Self-Storage Programs Applications)? Yes No
If yes, answer A-D.
a. Provide the complete physical address: ____________________________________________________
b. Describe the occupancy/use of this building: ________________________________________________
c. Provide the total Square Footage of this Building: ___________
d. Is separate General Liability Insurance in place for this building? Yes No
Do you own any other land? Yes No
If yes, answer A-D.
a. Provide the complete physical address: ____________________________________________________
b. Describe the use of this land: ____________________________________________________________
c. Provide the total acreage of this land: ___________
d. Is separate General Liability Insurance in place for this land? Yes No
11. Within the next year, do you have any plans for any building construction or renovations? Yes No
If yes, please describe the plans: _________________________________________________________________
12. Within the next year, do you have any plans for expansion at any of your existing locations? Yes No
If yes, please describe the plans: _________________________________________________________________
13. Within the next year, do you plan to acquire any other buildings or land? Yes No
If yes, please describe the plans: _________________________________________________________________
Applicant and Producer’s Signatures
APPLICANT: I UNDERSTAND THAT THIS APPLICATION FOR INSURANCE AND ANY POLICY ISSUED AS A RESULT OF THE APPROVAL OF
THIS APPLICATION WILL ONLY PROVIDE INSURANCE FOR SELF-STORAGE OPERATIONS AND ANY OTHER APPROVED OPPERATIONS
SCHEDULED ON THE ISSUED POLICY. I FURTHER UNDERSTAND THAT NO COVERAGE WILL BE PROVIDED FOR ANY OTHER BUSINESS,
OPERATIONS OR SERVICES UNLESS THEY ARE SPECIFICALLY ADDED TO ANY POLICY ISSUED FOR AN ADDITIONAL PREMIUM.
I BELIEVE THE STATEMENTS IN THIS APPLICATION ARE TRUE AND CORRECT. I UNDERSTAND THAT THE INSURER WILL RELY ON THESE
STATEMENTS IF A POLICY IS TO BE ISSUED. PROVIDING FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS FRAUD, WHICH
IS A CRIME IN MANY STATES.
Applicant’s Signature: ________________________________________________________________ Date: ________________
Applicant’s Name: ______________________________________________ Applicant’s Title: _____________________________
Submitting Producer’s Signature: _________________________________________________________________________________
Submitting Producer’s Name: ____________________________________________________________________________________
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Self- Storage Facility & Supplemental Application (All Risks, Ltd)

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Completed 15 July 2020

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