Rental Dwelling Protection Checklist
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Rental Dwelling Protection Checklist
Client Name
Insured Property Address
City
State
Zip
Policy Number
Renewal Date of Policy
Email
Home Phone
Work Phone
Cell Phone
Please indicate Yes, No, or Insured meaning you already have the coverage.
Question 1.
Have you remodeled your rental home, added any additions, built any outbuilding or garages, or made any improvements to finish the basement?
Please Select
Yes
No
Insured
Question 2.
Would it cost more to rebuild your rental home, than the amount you have it insured for?
Please Select
Yes
No
Insured
Question 3.
Have you updated the wiring, heating, roof or plumbing in your rental home?
Please Select
Yes
No
Insured
Details
Question 4.
Have you added a new security or fire alarm system to your rental home?(If so please provide us with the installation certificate to receive a discount.)
Please Select
Yes
No
Insured
Question 5.
Does your rental home have smoke detectors?
Please Select
Yes
No
Insured
If no, explain
Question 6.
Does your rental home have carbon monoxide detectors?
Please Select
Yes
No
Insured
If no, explain
Question 7.
Is your rental home currently tenant occupied?
Please Select
Yes
No
Insured
Question 8.
If Yes, do you require them to carry an HO-4 or tenant policy?
Please Select
Yes
No
Insured
Question 9.
Do you require your tenant to sign at least a 12-month lease?
Please Select
Yes
No
Insured
Question 10.
Do you conduct regular inspections of the property and have a preventative maintenance program?
Please Select
Yes
No
Insured
Question 11.
Does your tenant run any business out of your rental home, provide any babysitting services or give private lessons on your premises?
Please Select
Yes
No
Insured
Question 12.
Does your tenant have a trampoline?
Please Select
Yes
No
Insured
Question 13.
Do you allow your tenant to have pets? If so please list the type of pet, breed and how many?
Please Select
Yes
No
Insured
Type of Pet, breed and how many?
Question 14.
Have you refinanced or changed your mortgage company this year, if so what is the mortgage company’s name, address, loan number, and phone number?
Please Select
Yes
No
Insured
Info
Question 15.
Would you like to have Flood coverage – annual price begins at $320?
Please Select
Yes
No
Insured
Question 16.
Would you like to have Earthquake coverage– annual price begins at $120?
Please Select
Yes
No
Insured
Question 17.
Would you like to have backup of Sewer & Drain Backup Coverage?
Please Select
Yes
No
Insured
Question 18.
Would you be interested in obtaining information on a $1,000,000 Umbrella Liability Insurance policy that would protect you in the event of a catastrophic accident for as little as $150 per year?
Please Select
Yes
No
Insured
Question 19.
Would you like a FREE No Obligation Review of your families Life Insurance Needs?
Please Select
Yes
No
Insured
The name of the person that completed this form and the date. By typing your name and date below you are electronically signing this document acknowledging that all the information is true.
Name
Date
Do you have any additional comments?
Message
Thank you for completing this form. It is a very important part of your insurance protection. Your form will be reviewed to ensure we have all the information you indicated. If you have requested additional information we will contact you. If you would like to speak with a member of the O’Connor Insurance Team please check below.
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