REAL ESTATE QUESTIONNAIRE — POLLUTION & REMEDIATION LEGAL LIABILITY
THIS QUESTIONNAIRE WILL BE USED TO OBTAIN AN INDICATION OF PREMIUM AND COVERAGE TERMS. AN INDICATION WILL BE RECEIVED WITHIN TWO WORKING DAYS. PLEASE NOTE THAT A COMPLETED
NOTE:
General Contractors, Remediation Contractors, Industrial and Commercial Facilities: Unfortunately a quick indication is not possible for these industries.
Please contact us to obtain a quotation
.
This questionnaire is applicable for single sites or portfolios with less than 15 properties.
Please complete this questionnaire for each property to be insured.
Contact Information
Oct 11, 2008
1:44:12 PM
Name
Company
Phone
Email
Location Information
Covered Location Address
Age of Buildings
Building Square Feet
Acreage
Property Use
Office
Industrial
Retail
Habitational Other
Is the Property
Owned
Managed
Leased
How many years owned/managed/leased?
List the current occupants and operations
Does this property (or any occupant/tenants) generate, handle, store or dispose of any hazardous waste or materials?
Yes
No
If "Yes" please describe
Does this property have any history of use as a dry cleaning establishment?
Yes
No
Have any underground storage tanks (UST's) ever been located at this property?
Yes
No
If yes, do they meet 1998 EPA UST standards?
Yes
No
If removed, was a closure letter received from state for all UST's?
Yes
No
What were the previous uses of this property?
Have any environmental audits or studies been completed in the past five years?
Yes
No
If yes, provide name of consultant, type of report and date of report