Hotel / Motel - Renovation Questionnaire

Please complete a separate questionnaire for each building over 25 years old.
Broker
Date:
Business Name
Property:
Address:
BUILDING CONSTRUCTION INFORMATION:
Type of Construction:
Frame (1)
Masonry (2)
Masonry Non-Combustible (3-4)
Fire Resistive (5-6)
Type of Renovation:
Remodel - Interior Finishes Only
Restructuring - Minor Structural Changes (Incl. Walls, Floors, Roof)
Restoration - Major Structural Changes (Incl. Walls, Floor, Roof, Electrical, Heating, Pluming)
Reconstruction - Gutting of existing structure with only shell remaining.
Date of purchase:
Age of Structure:
Historical Landmark?
YesNo
(If YES Explain)
Date Remodeled:
Was the work performed by a General Contractor?
YesNo
No (If NO Explain)
Cost of Remodeling: $
What was the length of time under renovation:
1. ELECTRICAL:
Type of wiring?
BX CableRomexAluminumConduit Circuit BrkrsFusesBoth
Amperage Rating
100150200
Has the premises been rewired since the original construction:
Yes No
No (If NO Explain)
If yes, give the name of the electrical contractor that did the work:
Date completed?
2. HEATING & COOLING:
Primary
Wall FurnaceElectricGas HeaterFloor FurnaceForced Air Wood Stove
What type of fuel is used?
Secondary
Wood StoveElectric Space HeaterGas HeaterOther
Has the entire original heating system or furnace been replaced?
YesNo
(If NO Explain)
If yes, give the name of the heating contractor that did the work:
Date Completed?
3. PLUMBING
Pipes are:
CopperGalvanizedPlasticOther
Age of Hot Water System?
Has Pressure-Balancing Anti-Scald System been installed?
YesNo
Has any re plumbing been done since the original construction?
YesNo
If yes, to what extent?
Name of the plumbing contractor that did the work:
Date completed?
4. ROOF
Type of Roof:
TileCompositionWood / ShakeComp. ShingleOther
If other Explain
Has the roof been entirely replaced
YesNo
If yes, give the name of the roofing contractor who completed the work
Date completed?
5. STRUCTURAL
Is the INSURED a Builder, Developer or Contractor?
YesNo
If yes, did the insured do any of the remodeling work?
YesNo
If built prior to 1980, has an asbestos survey been conducted?
YesNo
Can you provide written proof asbestos material was removed?
YesNo
Are there any unprotected vertical openings (stairways, elevators etc.)
Yes No
Are all fire doors rated for one hour protection?
YesNo
Are the surrounding bldg.'s in good condition and maintenance?
YesNo
Has Structure(s) ever sustained damage from Earthquake or Wind?
YesNo
Other Comments:
 
NOTE:  Before transmitting this form via our website, please print a copy for your records and for the insured's signature.  We require that the insured sign this form and for the signed copy to be faxed to our office prior to binding.  Please note that coverage can't be bound or amended via this website.  You must receive a binder or written confirmation from our office for coverage to be bound.
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