APARTMENT HOUSE QUESTIONNAIRE
Please, fill out the form completely ( * Required field in order to process)

Have you received a quote from us before? Yes No   If yes, please provide Quote #: (usually 5 to 9 digits)
*Name:    *Business Name:
Business Address (including full address and zip code, No PO BOX):

Mailing Address (including full address and zip code, No PO BOX):

*Phone:     Fax:
*Email: *Please type in your email again:
Years in Business: Experience in Field: Owner's Name: FEIN or SS#:

PROPERTY
Building Limit: Rent Limit: Building Age:
Construction: # of Stories: Occupants:
Circuit Breakers: Yes No      Fire Alarm: Yes No      Central Station: Yes No
Burglar Alarm: Yes No     Sprinkler System: Yes No     Percentage Sprinkled: 0 25 50 75 100
Age of Roof: Plumbing Updates: Electrical Updates: Sq Ft of Building:

LIABILITY
# of Residential Units:    Sq Ft of Commercial Space:
Swimming Pool: Yes No      Playground: Yes No      Type of Commercial Units:
Has Building Been Tested for Lead Paint? Yes No      Results:
Smoke Detectors: Yes No     Battery Hard Wire
% of Subsidized Housing: # of Means of Egress: Current General Liability Limit:

GENERAL
Current Insurance Carrier: Premium: 5 Year Loss History:
Any Bankruptcy: Yes No     Expiration Date:
Any policy or coverage declined, canceled, or non-renewed during prior 3 years? Yes No     
Is there a guard or watchman? Yes No     24 hrs?: Yes No
Parking facilities: Owned Rented      # of cars:
Fee charged for parking? (amount):      # of cars:
Any uncorrected fire codes? Yes No
Are certificates of insurance obtained from contractors?   Yes No
Any ongoing or future construction projects planned?       Yes No
Describe:

MORTGAGEE INFO
Full Name and address:
Loan # (optional):  
Other important information we should know:

E mail:  Larisa Ayzina,  layzina@bfbond.com
Telephones (800) 921 1008 /  (212) 566 1881 Ext.114
Address 2 John Street suite 201  New York, NY 10038
www.bfbond.com