Manufactured Housing Insurance MANUFACTURED HOUSING COMMUNITIES
SECTION 1 of 3 SUPPLEMENTAL APPLICATION
Date of application:
Name of Community (Complete Legal Name):
Individual Partnership Corporation Limited Corporation Joint Venture Other
CONTACT INFORMATION
Contact Person (required): Phone:
Cell Phone: Fax:
Email (required): Website:
MAILING ADDRESS
Street Address: City:
State: Zip:
PARK INFORMATION Location of Community:
Community Address: City:
Year Park Was Built: Year Park Was Purchased:
Comments: (i.e. Does the community show pride of ownership? Describe the general condition, etc):
SECTION 2 of 3 Underwriting Information 1. Describe the occupancy of your community:
Are any of the above sites RV Spaces? Yes No Total number of RV sites: Number of permanent RV tenant occupied sites: (Including month-to-month rolling stock and park trailers) Number of short term/seasonal RV sites:
3. Rental receipts information:
4. Do you have units other than manufactured homes for rent in your park?
If you wish to insure these structures for property insurance, please include them on the property schedule/statement of values
5. Are there any commercial building(s) rented by others in the community?
6. Are there any rental units with more than four units per structure?
7. Do you have any overnight or short-term rental units (motel)?
8. Do you have any vacant land adjacent to or a part of this community? Yes No Number of acres: If the property has a different address or legal description, please describe:
Do you own or operate any other business in the community? Yes No
If so, describe:
9. Do you operate any of the following?
(If you operate a restaurant, snack bar or catering service, please complete separate Restaurant Questionnaire)
Do you sell alcoholic beverages? Yes No If so, describe operations: Take out liquor sales Annual Receipts: $ On premises services Annual Receipts: $ Is food and alcohol service open to the public? Yes No If so, describe:
Describe training provided for those who serve alcohol:
10. Are pets allowed? If yes, please send a copy of the pet rules. Yes No
Do you allow breeds such as Dobermans, Pit Bulls (Staffordshire Terriers), Rottweilers, Chows, wolf-hybrids, or other aggressive breeds? Yes No
11. Do any of your tenants have any commercial operations in your community? Yes No If so, describe:
12. Comments:
SECTION 3 of 3 General Information
1. Prior Insurance Information: Present insurance carrier: Policy number: Exp. Date: Premium: Have you ever had your insurance cancelled? Yes No If so, please explain:
Have you had any losses within the past three years? Please explain:
2. Management Experience: Are you a member of your State Community Owners Association? Yes No Are you a member of any other Association in relation to your business operation? Yes No If so, describe: Do you own any other communities? Yes No Do you have written rules and regulations and are they enforced? Yes No
Please E-mail a copy of the rules and regulations to: MHC-RVinto@totemagencies.com
If this is a new purchase and you have not previously owned manufactured housing communities, please describe your prior rental experience:
* Do you maintain a physical improvements and maintenance log? Yes No * Do you maintain a complaint log? Yes No * Do you require certificates of insurance, naming your community as an additional insured, from contractors and other vendors performing work in your community? Yes No What is the limit of liability you require? $
* ITEMS ARE MANDATORY. ASK YOUR AGENT IF YOU NEED HELP ATTAINING COMPLIANCE.
3. Employees: Do you have a manager on site? Yes No Full Time Part Time How many? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
Do you have any other employees? Yes No How many? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Annual payroll: $ Do your employees operate their own vehicles in the course of their work for you? Yes No If so, how many? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
Do you hire vehicles for use in the operation of your community? Yes No What type of vehicle do you hire? Annual Cost: $
4. Sales Operations: Do you sell new or used units? New Used Both If so, number of units: New: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Used: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Do your employees set up homes? Yes No
5. Community Description: Is the community inside the city limits: Yes No Name of responding fire department: Paid: Volunteer: Distance to fire station: Miles. Distance to hydrant: Feet.
Are units skirted? Yes No Tied down? Yes No Estimated average age of units in community:
Street construction: Paved Gravel Dirt Other: Street lighting: Full Partial None
6. Community Services: Are utilities underground? Yes No Is community on city sewer or septic ? Is garbage collection done by city or by private party ? Is community on city water or well ?
Do you sell LP Gas? Yes No Gallons/year: Annual receipts: $ Do you provide any other services (i.e. cable, telephone, etc)? Yes No If so, describe:
7. Do you provide space for RV storage? Yes No Is the RV storage secured with a locked fence? Yes No Do you have a vehicle wash facility? Yes No Are you responsible for damage to stored vehicles? Yes No
8. Is there a swimming pool in the community? Yes No If so, please complete this swimming pool questionnaire Number of pools
Do you have any of the following? Spa Hot Tub Whirlpool Sauna How many of each? Spas: Hot Tubs: Whirlpools: Saunas: Do you have any other water exposure? Yes No If so, describe: Lake Pond River Stream Ocean Other:
Do you have any dock or marina operations? Yes No If so, describe:
9. Do you have any of the following recreational facilities for your tenants? Tennis Court Sport Court Baseball Field: Remote control cars/aircraft course:
How many of each? Tennis Courts: Sport Courts: Baseball Field: Remote control courses:
Golf Course Holes Open to the public? Yes No Annual receipts: $ Golf Carts Loaned, no fee? If fee: Annual receipts: $
Bicycle Rentals Yes No Annual receipts: $ Other Describe:
10. Do you have any playgrounds? Yes No How many? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 If so, please complete this playground questionnaire Swings Slides Big Toy Jungle Gym Other:
11. Describe any community sponsored, tenant activities Wood Shop Lapidary Dances Pool Tournaments Potlucks Las Vegas Night Water Aerobics Games (baseball, basketball, etc) Describe:
12. Security: Are any security guard services provided for the community? Yes No Is the service provided by an independent contractor? Yes No Are the guards armed? Yes No Do you secure a certificate of insurance from the independent contractor naming the community as an additional insured: Yes No
13. Lawsuits and/or litigation: Are there now, or have there ever been, any suit or litigation involving a failure to maintain? Yes No If so, describe:
14. Do you have any park equipment that needs to be insured? Yes No If so, describe the equipment, including year, make, model, ID # and value:
15. Comments:
The Applicant warrants that all answers to the questions on this application are true and correct. Any person who, knowingly and with intent to defraud any insurance company or other person, files an application for insurance containing any false information, or conceals for the purpose of misleading information concerning any fact thereto, commits a fraudulent insurance act, which is a crime.
Kirkland, WA, 98033