Property & Liability A pplication - CSD Pool › wp-content › uploads › CSD-PL-Application-FINA… · Please list all district-owned property and contents (for more space, see

Administered by McGriff, Seibels & Williams, Inc. P. O. Box 1539 Portland, OR 97207

Page 1 of 16 Edition 2020

Property & Liability Application

Upon completion, please submit with the GL Supplement at [email protected] Questions? Call us at 800-318-8870, ext. 2

District name:

Desired effective date of coverage:

District physical address:

City, State, Zip:

Mailing Address (if different):

County:

Primary Contact:

Email: Phone:

Position:

Type of District:

If a Metropolitan district, what services are provided?

District’s Management Company (if applicable): This will be used as the district’s mailing address unless otherwise advised.

Name:

Mailing address:

City, State, Zip:

Phone: Email:

Primary Contact:

Position:

District’s Broker/Insurance Agent Name and Address (if applicable):

Name:

Mailing address:

City, State, Zip:

Phone: Email:

Primary Contact:

mailto:[email protected]



General Information:

1. Is the district currently a member of the Special District Association of Colorado? Yes ☐ No ☐

NOTE: The district must join the SDA in order to be a member of the CSD Pool

2. What Year was the district was formed:

3. FEIN:

4. Attach a copy of the district’s most recent budget

For a coverage comparison with the Pool’s proposal, please enclose a complete copy of all your current insurance policies

General Liability

5. Quote needed: Yes☐ No☐ 6. District self-insures liability coverage: Yes☐ No☐ 7. Complete the attached General Liability schedule for district exposures

Current Policy Information

Insurance company name Expiration date Deductible (if any) Expiring Premium Per occurrence coverage limit Policy type Claims-Made* Occurrence

*Retrospective date of Claims-Made policy:

Excess Liability

1. Quote needed: Yes☐ No☐ 2. Desired coverage limit: (Up to $8,000,000)


Insurance company name Expiration date Expiring Premium Coverage limit



Auto Coverage

1. Quote needed: Yes☐ No☐

Current Policy Information Insurance company name Expiration date Expiring Premium Auto Liability deductible (if any) Auto Liability premium Auto Physical Damage deductibles Comprehensive: Collision: Auto Physical Damage premium Coverage limit

Property Coverage

1. Quote needed: Yes☐ No☐ 2. Complete the Property and Inland Marine schedules or attach the schedules from your current

insurance policy

Current Policy Information Insurance company name Expiration date Deductible Earthquake coverage Flood coverage Loss of Income limit Expiring Premium Term Annual ☐ Multi-Year ☐

Equipment Breakdown/Boiler & Machinery Coverage

1. Quote needed: Yes☐ No☐

Current Policy Information Insurance company name Expiration date Deductible Loss of Income limit Expiring Premium Term Annual ☐ Multi-Year ☐



Crime Coverage

The Pool’s Crime coverage fulfills State Board Member bonding requirements.

1. Quote needed: Yes☐ No☐ 2. Number of full time employees: Number of part time employees: 3. Desired limit of coverage: $ ($5,000-$5,000,000)

An application is required for limits in excess of $500,000 4. Names of all ERISA plans:


Insurance company name Expiration date Deductible Expiring Premium Term Annual ☐ Multi-Year ☐

Public Officials Liability/Wrongful Acts Coverage

Public Officials Liability/Wrongful Acts coverage is automatically included in the Pool’s Public Entity Liability coverage document.


Insurance company name Expiration date Deductible Expiring Premium Limits – Each Occurrence/Aggregate Policy type Claims-made* ☐ Occurrence ☐ *If Claims-Made – Retroactive Date:

Cyber Coverage Cyber coverage is automatically included in the Pool’s Public Entity Liability coverage document.


Insurance company name Expiration date Deductible Expiring Premium Limits – Each Occurrence / Aggregate Coverage Types (liability, first party expenses, etc) Policy type Claims-made* ☐ Occurrence ☐ *If Claims-Made – Retroactive Date:



Loss History

Please complete the premium and loss history schedule below and attach a currently valued Loss Runs from your existing insurance carrier. By completing this information for the last eight years, it will enable the Pool to apply applicable credits.

Year Property General Liability Automobile

Liability Automobile

Physical Damage Public Officials

Liability Equipment Breakdown

Excess Liability Cyber

Premium Losses Premium Losses Premium Losses Premium Losses Premium Losses Premium Losses Premium Losses Premium Losses



Auto Schedule Please list all vehicles licensed for road use (for more space, see page 15). You may use your own spreadsheet/list of vehicles or a current copy of the vehicle schedule from your existing policy. Special equipment permanently attached or mounted on vehicles that is not factory installed (cherry pickers, augers, booms, fire engine equipment, accessories, etc.) should be included in the value of the vehicle and noted in “Model” of the vehicle. Do not include unlicensed equipment on this schedule – use the Equipment Schedule below.

Veh # Year Make Model VIN Weight Class Code Comprehensive

Deductible Collision

Deductible Valuation

Code Cost New /

Value

Weight Class Codes Code Description Gross Vehicle Weight Code Description Gross Vehicle Weight PP Private Passenger 0 - 10,000 lbs ME Light Light Mobile Equipment 0 - 10,000 lbs LT Light Truck 0 - 10,000 lbs ME Medium Medium Mobile Equipment 10,000 - 20,000 lbs MT Medium Truck 10,000 - 20,000 lbs ME Heavy Heavy Mobile Equipment 20,001 - 45,000 lbs HT Heavy Truck 20,001 - 45,000 lbs ME X-Heavy Extra Heavy Mobile Equipment Over 45,000 lbs XHT Extra Heavy Truck Over 45,000 lbs Trailer Trailer pulled by vehicle

Valuation Codes Code Description ACV Actual Cash Value GRC Guaranteed Replacement Cost AV Agreed Value



Driver Schedule Please list all employees, volunteers and board members who will drive any vehicle on district business. You may use your own spreadsheet/list of drivers.

Driver # State Licensed First Name Middle Name Last Name Driver’s License Number Date of Birth


Page 8 of 16 Edition: 2020

Property Schedule Please list all district-owned property and contents (for more space, see page 16). You may use your own spreadsheet/list of buildings and contents, or a current copy of the schedule from your existing policy. Valuation(s) must be 100% of the Replacement Cost. Definitions of the construction codes are below.

Loc# Location Address (or GPS) Required

Occupancy

Sq. Ft. Year Built

No. of Stories

% Sprinklered

Fire Prot. Class

Building Construction

Code

Valuation Code

Building Value

Contents Value

Computer Equipment

Value

Underground Pipes Value

Not Otherwise Classified*

Value

Definitions and Codes

Occupancy should show how the building is being used i.e. an office, station, park, etc. If the location is a well, provide us with more details under “Occupancy” such as a well house, the water system inside which consists of pumps, meters, chemicals and telemetry, etc and place the valuation under “Not Otherwise Classified”.

Fire protection class – the fire protection class can be obtained from your local fire department Property values –100% cost to replace the scheduled property * Items that do not fall into any of the other categories shown will fall under to NOC category. Property such as steel tanks, statues, bridges, spillways, and other non-conforming structures that are not technically buildings are all included.

Building Construction Codes (see pages 12 & 13 for a General Overview of each description) Valuation Codes Code Description Code Description Code Description FI Fire Resistive NC Non-Combustible ACV Actual Cash Value MF Modified Fire Resistive JM Joisted Masonry GRC Guaranteed Replacement Cost MN Masonry FR Frame AV Agreed Value

Administered by McGriff, Seibels & Williams, Inc. P. O. Box 1539

Portland, OR 97207


Equipment & Miscellaneous Items Schedule Please list all mobile equipment and miscellaneous items (such as tools). You may use your own spreadsheet/list of equipment or a current copy of the schedule from your existing policy.

PTC Year Make Model Serial No. Valuation Code Value(s)

Property Type Codes (PTC) Valuation Codes

Code Description Code Description AR Accounts Receivable ACV Actual Cash Value ART Fine Arts / Museum Collections RC Replacement Cost COM Mobile Communications EQP Mobile Equipment, not licensed for road use FD Fire Department Equipment TOL Tools


Portland, OR 97207


Outdoor Property Schedule Please list fencing, exterior signs (attached or detached), light poles, monuments, flagpoles, pavilions, playgrounds or park amenities (picnic tables, dog stations), paved or concrete walkways, driveways or parking lots, open shelters, fire hydrants, etc. You may use your own spreadsheet/list of outdoor property or a current copy of the schedule from your existing policy. Outdoor Property not scheduled is subject to the policy sublimit and actual cash valuation.

Loc # Location Address (or GPS) Required Property Description Value at Replacement Cost (RC)

NOTE: Outdoor Property Schedule should NOT include: Land, Land Improvements, Water, Lawns/Sod (these are excluded) Real Property, Contents, Underground pipes, NOC (place in Property Schedule on page 7) Equipment or tools (place these on the Equipment scheduled on page 8) Plants, trees or shrubs (place these in the schedule below)

Plants, Trees or Shrubs Schedule The policy provides a sub-limit of $25,000 for Plants, Trees or Shrubs but higher limits are available when scheduled. Please list below any higher values for these types of property.

Loc # Location Address (or GPS) Required Property Description Value at Actual Cash Value (ACV)

Trees Plants Flowers (annuals and/or perennials) Shrubs


Portland, OR 97207


Off-Premises Schedule Please list any owned property currently located away from the scheduled premises (examples are: a communication tower or antenna, property in a storage facility, etc).

Loc # Location Address (or GPS) Required Description of Property Year Built (if applicable)

Value at Actual Cash Value (ACV)


Portland, OR 97207


ADDITIONAL INTEREST SCHEDULE (*Loss Payee, Mortgagee, Lender’s Loss Payee) Property

Interest* Name Address City, State, Zip Code Loc. # Property Description Loan #

ADDITIONAL INTEREST SCHEDULE (**Loss Payee, Additional Insured or LP/AI if both) Automobile

Interest** Name Address City, State, Zip Code Vehicle # Vehicle Description Loan #


Portland, OR 97207


Property Classifications for Construction Codes: General Overview

FIRE RESISTIVE (FI) A fire resistive building must be constructed of any combination of the following materials: • Exterior walls or exterior structural frame

– Solid masonry, including reinforced concrete – Hollow masonry not less than 12 inches in thickness – Hollow masonry less than 12 inches, but not less than 8 inches in thickness, with a listed

fire resistance rating of not less than two hours – Assemblies with a fire resistance rating of not less than two hours

• Floors and roof – Monolithic floors and roof of reinforced concrete with slabs not less than 4 inches in thickness – Construction known as "joist systems" with slabs supported by concrete joists spaced not

more than 36 inches on centers with a slab thickness of not less than 2 3/4 inches – Floor and roof assemblies with a fire resistance rating of not less than two hours

• Structural metal supports – Horizontal and vertical load bearing protected metal supports (including pre-stressed or

post tensioned concrete units) with a fire resistance rating of not less than two hours.

Fire resistive construction is the best from an underwriting standpoint. The construction materials are either noncombustible with a fire resistive rating of at least two hours or they are protected through the use of a noncombustible covering such as plaster or gypsum to obtain such a rating.

MODIFIED FIRE RESISTIVE (MF) A modified fire resistive building has bearing walls (walls supporting the upper floors and roof) and columns of masonry or reinforced concrete construction, just as in the fire resistive category. However, the fire resistance rating of the materials is less than two hours but not less than one hour.

MASONRY NONCOMBUSTIBLE (MN) In the masonry noncombustible class are buildings with exterior walls of fire resistive construction with a rating of not less than one hour or buildings of masonry construction. Roof and floors must be of noncombustible or slow burning materials. The typical masonry noncombustible building has a masonry nonbearing wall surface, a cement floor, some type of metal deck roof, and unprotected steel webbing supported by unprotected columns and roof members. Low initial cost and low maintenance have made this type of construction extremely popular.

NONCOMBUSTIBLE (NC) A noncombustible building is a building with exterior walls, roof, and floor constructed of and supported by metal, asbestos, gypsum, or other noncombustible materials. While these buildings are noncombustible, they are not fire resistive. If this type of building is filled with combustible contents, structural failure is extremely likely in the event of a serious fire. The unprotected steel structural supports in this type of building will twist and bend when subjected to extreme heat.


Portland, OR 97207


JOISTED MASONRY (JM) Joisted masonry construction is also referred to as ordinary construction. The joisted masonry class includes buildings with exterior walls of fire resistive construction (not less than one hour) or of masonry construction. The interior framing and floors are of wood or other combustible material. Ordinary construction is also referred to as "brick", "wood joisted", or "brick joisted". Ordinary constructed buildings are found in most of the major metropolitan areas in the northern states. They are infrequently over three stories high, since the exterior walls must be bearing walls. The great majority of these were built prior to World War II. Consequently, underwriters are presented with the potential problems of age, deterioration, and determining proper insurance to value.

FRAME (FR) A frame building is one which has exterior walls constructed of wood or other combustible materials. Buildings of mixed construction, such as wood frame with brick veneer, stone veneer, aluminum siding, or stucco, are generally classified as frame buildings. A great many dwellings as well as small mercantile buildings are frame. The desirability of frame construction varies somewhat by geographical area. In some parts of the country, the better class of home is of joisted masonry construction. In areas where earthquakes are frequent, most dwellings are of frame construction with stucco. Frame is superior to masonry in its resistance to earthquakes.


Portland, OR 97207


SUPPLEMENTAL SCHEDULE

Auto Schedule Continued

Veh # Year Make Model VIN Weight Class Code Comprehensive

Deductible Collision

Deductible Valuation

Code Cost New /

Value


Portland, OR 97207


SUPPLEMENTAL SCHEDULE Property Schedule Continued

Loc# Location Address (or GPS) Required

Occupancy

Sq. Ft. Year Built

No. of Stories

% Sprinklered

Fire Prot. Class

Construction Code

Valuation Code

Building Value

Contents Value

Computer Equipment

Value

Underground Pipes Value

Not Otherwise Classified*

Value

General Information:General LiabilityExcess LiabilityCurrent Policy InformationAuto Coverage

Current Policy InformationProperty Coverage

Current Policy InformationEquipment Breakdown/Boiler & Machinery Coverage

Current Policy InformationCrime Coverage

Current Policy InformationPublic Officials Liability/Wrongful Acts Coverage

Current Policy InformationCyber Coverage

Current Policy InformationLoss HistoryAuto Schedule

Weight Class CodesValuation CodesDriver ScheduleProperty Schedule

Definitions and CodesBuilding Construction Codes (see pages 12 & 13 for a General Overview of each description) Valuation CodesEquipment & Miscellaneous Items Schedule

Property Type Codes (PTC) Valuation CodesOutdoor Property SchedulePlants, Trees or Shrubs ScheduleOff-Premises SchedulePropertyAutomobile

MODIFIED FIRE RESISTIVE (MF)MASONRY NONCOMBUSTIBLE (MN)NONCOMBUSTIBLE (NC)JOISTED MASONRY (JM)FRAME (FR)Auto Schedule ContinuedProperty Schedule Continued

District name: Desired effective date of coverage: District physical address: City State Zip: Mailing Address if different: County: Primary Contact: Email: Phone: Position: Type of District: If a Metropolitan district what services are provided 1: What Year was the district was formed: FEIN: Insurance company name: Expiration date: Deductible if any: Expiring Premium: Per occurrence coverage limit: Desired coverage limit: Number of full time employees: Number of part time employees: Desired limit of coverage: Names of all ERISA plans: YearRow1: PropertyPremium: General LiabilityPremium: Automobile LiabilityPremium: Automobile Physical DamagePremium: Public Officials LiabilityPremium: Equipment BreakdownPremium: Excess LiabilityPremium: CyberPremium: YearRow2: PropertyLosses: General LiabilityLosses: Automobile LiabilityLosses: Automobile Physical DamageLosses: Public Officials LiabilityLosses: Equipment BreakdownLosses: Excess LiabilityLosses: CyberLosses: YearRow3: PropertyPremium_2: General LiabilityPremium_2: Automobile LiabilityPremium_2: Automobile Physical DamagePremium_2: Public Officials LiabilityPremium_2: Equipment BreakdownPremium_2: Excess LiabilityPremium_2: CyberPremium_2: YearRow4: PropertyLosses_2: General LiabilityLosses_2: Automobile LiabilityLosses_2: Automobile Physical DamageLosses_2: Public Officials LiabilityLosses_2: Equipment BreakdownLosses_2: Excess LiabilityLosses_2: CyberLosses_2: YearRow5: PropertyPremium_3: General LiabilityPremium_3: Automobile LiabilityPremium_3: Automobile Physical DamagePremium_3: Public Officials LiabilityPremium_3: Equipment BreakdownPremium_3: Excess LiabilityPremium_3: CyberPremium_3: YearRow6: PropertyLosses_3: General LiabilityLosses_3: Automobile LiabilityLosses_3: Automobile Physical DamageLosses_3: Public Officials LiabilityLosses_3: Equipment BreakdownLosses_3: Excess LiabilityLosses_3: CyberLosses_3: YearRow7: PropertyPremium_4: General LiabilityPremium_4: Automobile LiabilityPremium_4: Automobile Physical DamagePremium_4: Public Officials LiabilityPremium_4: Equipment BreakdownPremium_4: Excess LiabilityPremium_4: CyberPremium_4: YearRow8: PropertyLosses_4: General LiabilityLosses_4: Automobile LiabilityLosses_4: Automobile Physical DamageLosses_4: Public Officials LiabilityLosses_4: Equipment BreakdownLosses_4: Excess LiabilityLosses_4: CyberLosses_4: YearRow9: PropertyPremium_5: General LiabilityPremium_5: Automobile LiabilityPremium_5: Automobile Physical DamagePremium_5: Public Officials LiabilityPremium_5: Equipment BreakdownPremium_5: Excess LiabilityPremium_5: CyberPremium_5: YearRow10: PropertyLosses_5: General LiabilityLosses_5: Automobile LiabilityLosses_5: Automobile Physical DamageLosses_5: Public Officials LiabilityLosses_5: Equipment BreakdownLosses_5: Excess LiabilityLosses_5: CyberLosses_5: YearRow11: PropertyPremium_6: General LiabilityPremium_6: Automobile LiabilityPremium_6: Automobile Physical DamagePremium_6: Public Officials LiabilityPremium_6: Equipment BreakdownPremium_6: Excess LiabilityPremium_6: CyberPremium_6: YearRow12: PropertyLosses_6: General LiabilityLosses_6: Automobile LiabilityLosses_6: Automobile Physical DamageLosses_6: Public Officials LiabilityLosses_6: Equipment BreakdownLosses_6: Excess LiabilityLosses_6: CyberLosses_6: YearRow13: PropertyPremium_7: General LiabilityPremium_7: Automobile LiabilityPremium_7: Automobile Physical DamagePremium_7: Public Officials LiabilityPremium_7: Equipment BreakdownPremium_7: Excess LiabilityPremium_7: CyberPremium_7: YearRow14: PropertyLosses_7: General LiabilityLosses_7: Automobile LiabilityLosses_7: Automobile Physical DamageLosses_7: Public Officials LiabilityLosses_7: Equipment BreakdownLosses_7: Excess LiabilityLosses_7: CyberLosses_7: YearRow15: PropertyPremium_8: General LiabilityPremium_8: Automobile LiabilityPremium_8: Automobile Physical DamagePremium_8: Public Officials LiabilityPremium_8: Equipment BreakdownPremium_8: Excess LiabilityPremium_8: CyberPremium_8: YearRow16: PropertyLosses_8: General LiabilityLosses_8: Automobile LiabilityLosses_8: Automobile Physical DamageLosses_8: Public Officials LiabilityLosses_8: Equipment BreakdownLosses_8: Excess LiabilityLosses_8: CyberLosses_8: Veh Row1: YearRow1_2: MakeRow1: ModelRow1: VINRow1: Weight Class CodeRow1: Comprehensive DeductibleRow1: Collision DeductibleRow1: Valuation CodeRow1: Cost New ValueRow1: Veh Row2: YearRow2_2: MakeRow2: ModelRow2: VINRow2: Weight Class CodeRow2: Comprehensive DeductibleRow2: Collision DeductibleRow2: Valuation CodeRow2: Cost New ValueRow2: Veh Row3: YearRow3_2: MakeRow3: ModelRow3: VINRow3: Weight Class CodeRow3: Comprehensive DeductibleRow3: Collision DeductibleRow3: Valuation CodeRow3: Cost New ValueRow3: Veh Row4: YearRow4_2: MakeRow4: ModelRow4: VINRow4: Weight Class CodeRow4: Comprehensive DeductibleRow4: Collision DeductibleRow4: Valuation CodeRow4: Cost New ValueRow4: Veh Row5: YearRow5_2: MakeRow5: ModelRow5: VINRow5: Weight Class CodeRow5: Comprehensive DeductibleRow5: Collision DeductibleRow5: Valuation CodeRow5: Cost New ValueRow5: Veh Row6: YearRow6_2: MakeRow6: ModelRow6: VINRow6: Weight Class CodeRow6: Comprehensive DeductibleRow6: Collision DeductibleRow6: Valuation CodeRow6: Cost New ValueRow6: Veh Row7: YearRow7_2: MakeRow7: ModelRow7: VINRow7: Weight Class CodeRow7: Comprehensive DeductibleRow7: Collision DeductibleRow7: Valuation CodeRow7: Cost New ValueRow7: Veh Row8: YearRow8_2: MakeRow8: ModelRow8: VINRow8: Weight Class CodeRow8: Comprehensive DeductibleRow8: Collision DeductibleRow8: Valuation CodeRow8: Cost New ValueRow8: Veh Row9: YearRow9_2: MakeRow9: ModelRow9: VINRow9: Weight Class CodeRow9: Comprehensive DeductibleRow9: Collision DeductibleRow9: Valuation CodeRow9: Cost New ValueRow9: Veh Row10: YearRow10_2: MakeRow10: ModelRow10: VINRow10: Weight Class CodeRow10: Comprehensive DeductibleRow10: Collision DeductibleRow10: Valuation CodeRow10: Cost New ValueRow10: Veh Row11: YearRow11_2: MakeRow11: ModelRow11: VINRow11: Weight Class CodeRow11: Comprehensive DeductibleRow11: Collision DeductibleRow11: Valuation CodeRow11: Cost New ValueRow11: Veh Row12: YearRow12_2: MakeRow12: ModelRow12: VINRow12: Weight Class CodeRow12: Comprehensive DeductibleRow12: Collision DeductibleRow12: Valuation CodeRow12: Cost New ValueRow12: Veh Row13: YearRow13_2: MakeRow13: ModelRow13: VINRow13: Weight Class CodeRow13: Comprehensive DeductibleRow13: Collision DeductibleRow13: Valuation CodeRow13: Cost New ValueRow13: Veh Row14: YearRow14_2: MakeRow14: ModelRow14: VINRow14: Weight Class CodeRow14: Comprehensive DeductibleRow14: Collision DeductibleRow14: Valuation CodeRow14: Cost New ValueRow14: Driver Row1: State LicensedRow1: First NameRow1: Middle NameRow1: Last NameRow1: Drivers License NumberRow1: Date of BirthRow1: Driver Row2: State LicensedRow2: First NameRow2: Middle NameRow2: Last NameRow2: Drivers License NumberRow2: Date of BirthRow2: Driver Row3: State LicensedRow3: First NameRow3: Middle NameRow3: Last NameRow3: Drivers License NumberRow3: Date of BirthRow3: Driver Row4: State LicensedRow4: First NameRow4: Middle NameRow4: Last NameRow4: Drivers License NumberRow4: Date of BirthRow4: Driver Row5: State LicensedRow5: First NameRow5: Middle NameRow5: Last NameRow5: Drivers License NumberRow5: Date of BirthRow5: Driver Row6: State LicensedRow6: First NameRow6: Middle NameRow6: Last NameRow6: Drivers License NumberRow6: Date of BirthRow6: Driver Row7: State LicensedRow7: First NameRow7: Middle NameRow7: Last NameRow7: Drivers License NumberRow7: Date of BirthRow7: Driver Row8: State LicensedRow8: First NameRow8: Middle NameRow8: Last NameRow8: Drivers License NumberRow8: Date of BirthRow8: Driver Row9: State LicensedRow9: First NameRow9: Middle NameRow9: Last NameRow9: Drivers License NumberRow9: Date of BirthRow9: Driver Row10: State LicensedRow10: First NameRow10: Middle NameRow10: Last NameRow10: Drivers License NumberRow10: Date of BirthRow10: Driver Row11: State LicensedRow11: First NameRow11: Middle NameRow11: Last NameRow11: Drivers License NumberRow11: Date of BirthRow11: Driver Row12: State LicensedRow12: First NameRow12: Middle NameRow12: Last NameRow12: Drivers License NumberRow12: Date of BirthRow12: Driver Row13: State LicensedRow13: First NameRow13: Middle NameRow13: Last NameRow13: Drivers License NumberRow13: Date of BirthRow13: Driver Row14: State LicensedRow14: First NameRow14: Middle NameRow14: Last NameRow14: Drivers License NumberRow14: Date of BirthRow14: Driver Row15: State LicensedRow15: First NameRow15: Middle NameRow15: Last NameRow15: Drivers License NumberRow15: Date of BirthRow15: Driver Row16: State LicensedRow16: First NameRow16: Middle NameRow16: Last NameRow16: Drivers License NumberRow16: Date of BirthRow16: Driver Row17: State LicensedRow17: First NameRow17: Middle NameRow17: Last NameRow17: Drivers License NumberRow17: Date of BirthRow17: Driver Row18: State LicensedRow18: First NameRow18: Middle NameRow18: Last NameRow18: Drivers License NumberRow18: Date of BirthRow18: Driver Row19: State LicensedRow19: First NameRow19: Middle NameRow19: Last NameRow19: Drivers License NumberRow19: Date of BirthRow19: Driver Row20: State LicensedRow20: First NameRow20: Middle NameRow20: Last NameRow20: Drivers License NumberRow20: Date of BirthRow20: Driver Row21: State LicensedRow21: First NameRow21: Middle NameRow21: Last NameRow21: Drivers License NumberRow21: Date of BirthRow21: Driver Row22: State LicensedRow22: First NameRow22: Middle NameRow22: Last NameRow22: Drivers License NumberRow22: Date of BirthRow22: Driver Row23: State LicensedRow23: First NameRow23: Middle NameRow23: Last NameRow23: Drivers License NumberRow23: Date of BirthRow23: Driver Row24: State LicensedRow24: First NameRow24: Middle NameRow24: Last NameRow24: Drivers License NumberRow24: Date of BirthRow24: Driver Row25: State LicensedRow25: First NameRow25: Middle NameRow25: Last NameRow25: Drivers License NumberRow25: Date of BirthRow25: Driver Row26: State LicensedRow26: First NameRow26: Middle NameRow26: Last NameRow26: Drivers License NumberRow26: Date of BirthRow26: LocRow1: Location Address or GPS RequiredRow1: OccupancyRow1: Sq FtRow1: Year BuiltRow1: No of StoriesRow1: SprinkleredRow1: Fire Prot ClassRow1: Building Construction CodeRow1: Valuation CodeRow1_2: Building ValueRow1: Contents ValueRow1: Computer Equipment ValueRow1: Underground Pipes ValueRow1: Not Otherwise Classified ValueRow1: LocRow2: Location Address or GPS RequiredRow2: OccupancyRow2: Sq FtRow2: Year BuiltRow2: No of StoriesRow2: SprinkleredRow2: Fire Prot ClassRow2: Building Construction CodeRow2: Valuation CodeRow2_2: Building ValueRow2: Contents ValueRow2: Computer Equipment ValueRow2: Underground Pipes ValueRow2: Not Otherwise Classified ValueRow2: LocRow3: Location Address or GPS RequiredRow3: OccupancyRow3: Sq FtRow3: Year BuiltRow3: No of StoriesRow3: SprinkleredRow3: Fire Prot ClassRow3: Building Construction CodeRow3: Valuation CodeRow3_2: Building ValueRow3: Contents ValueRow3: Computer Equipment ValueRow3: Underground Pipes ValueRow3: Not Otherwise Classified ValueRow3: LocRow4: Location Address or GPS RequiredRow4: OccupancyRow4: Sq FtRow4: Year BuiltRow4: No of StoriesRow4: SprinkleredRow4: Fire Prot ClassRow4: Building Construction CodeRow4: Valuation CodeRow4_2: Building ValueRow4: Contents ValueRow4: Computer Equipment ValueRow4: Underground Pipes ValueRow4: Not Otherwise Classified ValueRow4: LocRow5: Location Address or GPS RequiredRow5: OccupancyRow5: Sq FtRow5: Year BuiltRow5: No of StoriesRow5: SprinkleredRow5: Fire Prot ClassRow5: Building Construction CodeRow5: Valuation CodeRow5_2: Building ValueRow5: Contents ValueRow5: Computer Equipment ValueRow5: Underground Pipes ValueRow5: Not Otherwise Classified ValueRow5: LocRow6: Location Address or GPS RequiredRow6: OccupancyRow6: Sq FtRow6: Year BuiltRow6: No of StoriesRow6: SprinkleredRow6: Fire Prot ClassRow6: Building Construction CodeRow6: Valuation CodeRow6_2: Building ValueRow6: Contents ValueRow6: Computer Equipment ValueRow6: Underground Pipes ValueRow6: Not Otherwise Classified ValueRow6: LocRow7: Location Address or GPS RequiredRow7: OccupancyRow7: Sq FtRow7: Year BuiltRow7: No of StoriesRow7: SprinkleredRow7: Fire Prot ClassRow7: Building Construction CodeRow7: Valuation CodeRow7_2: Building ValueRow7: Contents ValueRow7: Computer Equipment ValueRow7: Underground Pipes ValueRow7: Not Otherwise Classified ValueRow7: LocRow8: Location Address or GPS RequiredRow8: OccupancyRow8: Sq FtRow8: Year BuiltRow8: No of StoriesRow8: SprinkleredRow8: Fire Prot ClassRow8: Building Construction CodeRow8: Valuation CodeRow8_2: Building ValueRow8: Contents ValueRow8: Computer Equipment ValueRow8: Underground Pipes ValueRow8: Not Otherwise Classified ValueRow8: LocRow9: Location Address or GPS RequiredRow9: OccupancyRow9: Sq FtRow9: Year BuiltRow9: No of StoriesRow9: SprinkleredRow9: Fire Prot ClassRow9: Building Construction CodeRow9: Valuation CodeRow9_2: Building ValueRow9: Contents ValueRow9: Computer Equipment ValueRow9: Underground Pipes ValueRow9: Not Otherwise Classified ValueRow9: LocRow10: Location Address or GPS RequiredRow10: OccupancyRow10: Sq FtRow10: Year BuiltRow10: No of StoriesRow10: SprinkleredRow10: Fire Prot ClassRow10: Building Construction CodeRow10: Valuation CodeRow10_2: Building ValueRow10: Contents ValueRow10: Computer Equipment ValueRow10: Underground Pipes ValueRow10: Not Otherwise Classified ValueRow10: LocRow11: Location Address or GPS RequiredRow11: OccupancyRow11: Sq FtRow11: Year BuiltRow11: No of StoriesRow11: SprinkleredRow11: Fire Prot ClassRow11: Building Construction CodeRow11: Valuation CodeRow11_2: Building ValueRow11: Contents ValueRow11: Computer Equipment ValueRow11: Underground Pipes ValueRow11: Not Otherwise Classified ValueRow11: PTCRow1: YearRow1_3: MakeRow1_2: ModelRow1_2: Serial NoRow1: Valuation CodeRow1_3: ValuesRow1: PTCRow2: YearRow2_3: MakeRow2_2: ModelRow2_2: Serial NoRow2: Valuation CodeRow2_3: ValuesRow2: PTCRow3: YearRow3_3: MakeRow3_2: ModelRow3_2: Serial NoRow3: Valuation CodeRow3_3: ValuesRow3: PTCRow4: YearRow4_3: MakeRow4_2: ModelRow4_2: Serial NoRow4: Valuation CodeRow4_3: ValuesRow4: PTCRow5: YearRow5_3: MakeRow5_2: ModelRow5_2: Serial NoRow5: Valuation CodeRow5_3: ValuesRow5: PTCRow6: YearRow6_3: MakeRow6_2: ModelRow6_2: Serial NoRow6: Valuation CodeRow6_3: ValuesRow6: PTCRow7: YearRow7_3: MakeRow7_2: ModelRow7_2: Serial NoRow7: Valuation CodeRow7_3: ValuesRow7: PTCRow8: YearRow8_3: MakeRow8_2: ModelRow8_2: Serial NoRow8: Valuation CodeRow8_3: ValuesRow8: PTCRow9: YearRow9_3: MakeRow9_2: ModelRow9_2: Serial NoRow9: Valuation CodeRow9_3: ValuesRow9: PTCRow10: YearRow10_3: MakeRow10_2: ModelRow10_2: Serial NoRow10: Valuation CodeRow10_3: ValuesRow10: PTCRow11: YearRow11_3: MakeRow11_2: ModelRow11_2: Serial NoRow11: Valuation CodeRow11_3: ValuesRow11: PTCRow12: YearRow12_3: MakeRow12_2: ModelRow12_2: Serial NoRow12: Valuation CodeRow12_2: ValuesRow12: PTCRow13: YearRow13_3: MakeRow13_2: ModelRow13_2: Serial NoRow13: Valuation CodeRow13_2: ValuesRow13: PTCRow14: YearRow14_3: MakeRow14_2: ModelRow14_2: Serial NoRow14: Valuation CodeRow14_2: ValuesRow14: PTCRow15: YearRow15_2: MakeRow15: ModelRow15: Serial NoRow15: Valuation CodeRow15: ValuesRow15: PTCRow16: YearRow16_2: MakeRow16: ModelRow16: Serial NoRow16: Valuation CodeRow16: ValuesRow16: PTCRow17: YearRow17: MakeRow17: ModelRow17: Serial NoRow17: Valuation CodeRow17: ValuesRow17: PTCRow18: YearRow18: MakeRow18: ModelRow18: Serial NoRow18: Valuation CodeRow18: ValuesRow18: Loc Row1: Location Address or GPS RequiredRow1_2: Property DescriptionRow1: Value at Replacement Cost RCRow1: Loc Row2: Location Address or GPS RequiredRow2_2: Property DescriptionRow2: Value at Replacement Cost RCRow2: Loc Row3: Location Address or GPS RequiredRow3_2: Property DescriptionRow3: Value at Replacement Cost RCRow3: Loc Row4: Location Address or GPS RequiredRow4_2: Property DescriptionRow4: Value at Replacement Cost RCRow4: Loc Row5: Location Address or GPS RequiredRow5_2: Property DescriptionRow5: Value at Replacement Cost RCRow5: Loc Row6: Location Address or GPS RequiredRow6_2: Property DescriptionRow6: Value at Replacement Cost RCRow6: Loc Row7: Location Address or GPS RequiredRow7_2: Property DescriptionRow7: Value at Replacement Cost RCRow7: Loc Row8: Location Address or GPS RequiredRow8_2: Property DescriptionRow8: Value at Replacement Cost RCRow8: Loc Row1_2: Location Address or GPS RequiredRow1_3: Value at Actual Cash Value ACVTrees: Loc Row2_2: Location Address or GPS RequiredRow2_3: Value at Actual Cash Value ACVPlants: Loc Row3_2: Location Address or GPS RequiredRow3_3: Value at Actual Cash Value ACVFlowers annuals andor perennials: Loc Row4_2: Location Address or GPS RequiredRow4_3: Value at Actual Cash Value ACVShrubs: Loc Row1_3: Location Address or GPS RequiredRow1_4: Description of PropertyRow1: Year Built if applicableRow1: Value at Actual Cash Value ACVRow1: Loc Row2_3: Location Address or GPS RequiredRow2_4: Description of PropertyRow2: Year Built if applicableRow2: Value at Actual Cash Value ACVRow2: Loc Row3_3: Location Address or GPS RequiredRow3_4: Description of PropertyRow3: Year Built if applicableRow3: Value at Actual Cash Value ACVRow3: Loc Row4_3: Location Address or GPS RequiredRow4_4: Description of PropertyRow4: Year Built if applicableRow4: Value at Actual Cash Value ACVRow4: Loc Row5_2: Location Address or GPS RequiredRow5_3: Description of PropertyRow5: Year Built if applicableRow5: Value at Actual Cash Value ACVRow5: Loc Row6_2: Location Address or GPS RequiredRow6_3: Description of PropertyRow6: Year Built if applicableRow6: Value at Actual Cash Value ACVRow6: Loc Row7_2: Location Address or GPS RequiredRow7_3: Description of PropertyRow7: Year Built if applicableRow7: Value at Actual Cash Value ACVRow7: Loc Row8_2: Location Address or GPS RequiredRow8_3: Description of PropertyRow8: Year Built if applicableRow8: Value at Actual Cash Value ACVRow8: Loc Row9: Location Address or GPS RequiredRow9_2: Description of PropertyRow9: Year Built if applicableRow9: Value at Actual Cash Value ACVRow9: InterestRow1: NameRow1: AddressRow1: City State Zip CodeRow1: Loc Row1_4: Property DescriptionRow1_2: Loan Row1: InterestRow2: NameRow2: AddressRow2: City State Zip CodeRow2: Loc Row2_4: Property DescriptionRow2_2: Loan Row2: InterestRow3: NameRow3: AddressRow3: City State Zip CodeRow3: Loc Row3_4: Property DescriptionRow3_2: Loan Row3: InterestRow4: NameRow4: AddressRow4: City State Zip CodeRow4: Loc Row4_4: Property DescriptionRow4_2: Loan Row4: InterestRow5: NameRow5: AddressRow5: City State Zip CodeRow5: Loc Row5_3: Property DescriptionRow5_2: Loan Row5: InterestRow6: NameRow6: AddressRow6: City State Zip CodeRow6: Loc Row6_3: Property DescriptionRow6_2: Loan Row6: InterestRow7: NameRow7: AddressRow7: City State Zip CodeRow7: Loc Row7_3: Property DescriptionRow7_2: Loan Row7: InterestRow8: NameRow8: AddressRow8: City State Zip CodeRow8: Loc Row8_3: Property DescriptionRow8_2: Loan Row8: InterestRow9: NameRow9: AddressRow9: City State Zip CodeRow9: Loc Row9_2: Property DescriptionRow9: Loan Row9: InterestRow1_2: NameRow1_2: AddressRow1_2: City State Zip CodeRow1_2: Vehicle Row1: Vehicle DescriptionRow1: Loan Row1_2: InterestRow2_2: NameRow2_2: AddressRow2_2: City State Zip CodeRow2_2: Vehicle Row2: Vehicle DescriptionRow2: Loan Row2_2: InterestRow3_2: NameRow3_2: AddressRow3_2: City State Zip CodeRow3_2: Vehicle Row3: Vehicle DescriptionRow3: Loan Row3_2: InterestRow4_2: NameRow4_2: AddressRow4_2: City State Zip CodeRow4_2: Vehicle Row4: Vehicle DescriptionRow4: Loan Row4_2: InterestRow5_2: NameRow5_2: AddressRow5_2: City State Zip CodeRow5_2: Vehicle Row5: Vehicle DescriptionRow5: Loan Row5_2: InterestRow6_2: NameRow6_2: AddressRow6_2: City State Zip CodeRow6_2: Vehicle Row6: Vehicle DescriptionRow6: Loan Row6_2: InterestRow7_2: NameRow7_2: AddressRow7_2: City State Zip CodeRow7_2: Vehicle Row7: Vehicle DescriptionRow7: Loan Row7_2: InterestRow8_2: NameRow8_2: AddressRow8_2: City State Zip CodeRow8_2: Vehicle Row8: Vehicle DescriptionRow8: Loan Row8_2: InterestRow9_2: NameRow9_2: AddressRow9_2: City State Zip CodeRow9_2: Vehicle Row9: Vehicle DescriptionRow9: Loan Row9_2: Veh Row1_2: YearRow1_4: MakeRow1_3: ModelRow1_3: VINRow1_2: Weight Class CodeRow1_2: Comprehensive DeductibleRow1_2: Collision DeductibleRow1_2: Valuation CodeRow1_4: Cost New ValueRow1_2: Veh Row2_2: YearRow2_4: MakeRow2_3: ModelRow2_3: VINRow2_2: Weight Class CodeRow2_2: Comprehensive DeductibleRow2_2: Collision DeductibleRow2_2: Valuation CodeRow2_4: Cost New ValueRow2_2: Veh Row3_2: YearRow3_4: MakeRow3_3: ModelRow3_3: VINRow3_2: Weight Class CodeRow3_2: Comprehensive DeductibleRow3_2: Collision DeductibleRow3_2: Valuation CodeRow3_4: Cost New ValueRow3_2: Veh Row4_2: YearRow4_4: MakeRow4_3: ModelRow4_3: VINRow4_2: Weight Class CodeRow4_2: Comprehensive DeductibleRow4_2: Collision DeductibleRow4_2: Valuation CodeRow4_4: Cost New ValueRow4_2: Veh Row5_2: YearRow5_4: MakeRow5_3: ModelRow5_3: VINRow5_2: Weight Class CodeRow5_2: Comprehensive DeductibleRow5_2: Collision DeductibleRow5_2: Valuation CodeRow5_4: Cost New ValueRow5_2: Veh Row6_2: YearRow6_4: MakeRow6_3: ModelRow6_3: VINRow6_2: Weight Class CodeRow6_2: Comprehensive DeductibleRow6_2: Collision DeductibleRow6_2: Valuation CodeRow6_4: Cost New ValueRow6_2: Veh Row7_2: YearRow7_4: MakeRow7_3: ModelRow7_3: VINRow7_2: Weight Class CodeRow7_2: Comprehensive DeductibleRow7_2: Collision DeductibleRow7_2: Valuation CodeRow7_4: Cost New ValueRow7_2: Veh Row8_2: YearRow8_4: MakeRow8_3: ModelRow8_3: VINRow8_2: Weight Class CodeRow8_2: Comprehensive DeductibleRow8_2: Collision DeductibleRow8_2: Valuation CodeRow8_4: Cost New ValueRow8_2: Veh Row9_2: YearRow9_4: MakeRow9_3: ModelRow9_3: VINRow9_2: Weight Class CodeRow9_2: Comprehensive DeductibleRow9_2: Collision DeductibleRow9_2: Valuation CodeRow9_4: Cost New ValueRow9_2: Veh Row10_2: YearRow10_4: MakeRow10_3: ModelRow10_3: VINRow10_2: Weight Class CodeRow10_2: Comprehensive DeductibleRow10_2: Collision DeductibleRow10_2: Valuation CodeRow10_4: Cost New ValueRow10_2: Veh Row11_2: YearRow11_4: MakeRow11_3: ModelRow11_3: VINRow11_2: Weight Class CodeRow11_2: Comprehensive DeductibleRow11_2: Collision DeductibleRow11_2: Valuation CodeRow11_4: Cost New ValueRow11_2: Veh Row12_2: YearRow12_4: MakeRow12_3: ModelRow12_3: VINRow12_2: Weight Class CodeRow12_2: Comprehensive DeductibleRow12_2: Collision DeductibleRow12_2: Valuation CodeRow12_3: Cost New ValueRow12_2: Veh Row13_2: YearRow13_4: MakeRow13_3: ModelRow13_3: VINRow13_2: Weight Class CodeRow13_2: Comprehensive DeductibleRow13_2: Collision DeductibleRow13_2: Valuation CodeRow13_3: Cost New ValueRow13_2: Veh Row14_2: YearRow14_4: MakeRow14_3: ModelRow14_3: VINRow14_2: Weight Class CodeRow14_2: Comprehensive DeductibleRow14_2: Collision DeductibleRow14_2: Valuation CodeRow14_3: Cost New ValueRow14_2: Veh Row15: YearRow15_3: MakeRow15_2: ModelRow15_2: VINRow15: Weight Class CodeRow15: Comprehensive DeductibleRow15: Collision DeductibleRow15: Valuation CodeRow15_2: Cost New ValueRow15: Veh Row16: YearRow16_3: MakeRow16_2: ModelRow16_2: VINRow16: Weight Class CodeRow16: Comprehensive DeductibleRow16: Collision DeductibleRow16: Valuation CodeRow16_2: Cost New ValueRow16: Veh Row17: YearRow17_2: MakeRow17_2: ModelRow17_2: VINRow17: Weight Class CodeRow17: Comprehensive DeductibleRow17: Collision DeductibleRow17: Valuation CodeRow17_2: Cost New ValueRow17: Veh Row18: YearRow18_2: MakeRow18_2: ModelRow18_2: VINRow18: Weight Class CodeRow18: Comprehensive DeductibleRow18: Collision DeductibleRow18: Valuation CodeRow18_2: Cost New ValueRow18: Veh Row19: YearRow19: MakeRow19: ModelRow19: VINRow19: Weight Class CodeRow19: Comprehensive DeductibleRow19: Collision DeductibleRow19: Valuation CodeRow19: Cost New ValueRow19: Veh Row20: YearRow20: MakeRow20: ModelRow20: VINRow20: Weight Class CodeRow20: Comprehensive DeductibleRow20: Collision DeductibleRow20: Valuation CodeRow20: Cost New ValueRow20: Veh Row21: YearRow21: MakeRow21: ModelRow21: VINRow21: Weight Class CodeRow21: Comprehensive DeductibleRow21: Collision DeductibleRow21: Valuation CodeRow21: Cost New ValueRow21: Veh Row22: YearRow22: MakeRow22: ModelRow22: VINRow22: Weight Class CodeRow22: Comprehensive DeductibleRow22: Collision DeductibleRow22: Valuation CodeRow22: Cost New ValueRow22: Veh Row23: YearRow23: MakeRow23: ModelRow23: VINRow23: Weight Class CodeRow23: Comprehensive DeductibleRow23: Collision DeductibleRow23: Valuation CodeRow23: Cost New ValueRow23: Veh Row24: YearRow24: MakeRow24: ModelRow24: VINRow24: Weight Class CodeRow24: Comprehensive DeductibleRow24: Collision DeductibleRow24: Valuation CodeRow24: Cost New ValueRow24: Veh Row25: YearRow25: MakeRow25: ModelRow25: VINRow25: Weight Class CodeRow25: Comprehensive DeductibleRow25: Collision DeductibleRow25: Valuation CodeRow25: Cost New ValueRow25: Veh Row26: YearRow26: MakeRow26: ModelRow26: VINRow26: Weight Class CodeRow26: Comprehensive DeductibleRow26: Collision DeductibleRow26: Valuation CodeRow26: Cost New ValueRow26: Veh Row27: YearRow27: MakeRow27: ModelRow27: VINRow27: Weight Class CodeRow27: Comprehensive DeductibleRow27: Collision DeductibleRow27: Valuation CodeRow27: Cost New ValueRow27: LocRow1_2: Location Address or GPS RequiredRow1_5: OccupancyRow1_2: Sq FtRow1_2: Year BuiltRow1_2: No of StoriesRow1_2: SprinkleredRow1_2: Fire Prot ClassRow1_2: Construction CodeRow1: Valuation CodeRow1_5: Building ValueRow1_2: Contents ValueRow1_2: Computer Equipment ValueRow1_2: Underground Pipes ValueRow1_2: Not Otherwise Classified ValueRow1_2: LocRow2_2: Location Address or GPS RequiredRow2_5: OccupancyRow2_2: Sq FtRow2_2: Year BuiltRow2_2: No of StoriesRow2_2: SprinkleredRow2_2: Fire Prot ClassRow2_2: Construction CodeRow2: Valuation CodeRow2_5: Building ValueRow2_2: Contents ValueRow2_2: Computer Equipment ValueRow2_2: Underground Pipes ValueRow2_2: Not Otherwise Classified ValueRow2_2: LocRow3_2: Location Address or GPS RequiredRow3_5: OccupancyRow3_2: Sq FtRow3_2: Year BuiltRow3_2: No of StoriesRow3_2: SprinkleredRow3_2: Fire Prot ClassRow3_2: Construction CodeRow3: Valuation CodeRow3_5: Building ValueRow3_2: Contents ValueRow3_2: Computer Equipment ValueRow3_2: Underground Pipes ValueRow3_2: Not Otherwise Classified ValueRow3_2: LocRow4_2: Location Address or GPS RequiredRow4_5: OccupancyRow4_2: Sq FtRow4_2: Year BuiltRow4_2: No of StoriesRow4_2: SprinkleredRow4_2: Fire Prot ClassRow4_2: Construction CodeRow4: Valuation CodeRow4_5: Building ValueRow4_2: Contents ValueRow4_2: Computer Equipment ValueRow4_2: Underground Pipes ValueRow4_2: Not Otherwise Classified ValueRow4_2: LocRow5_2: Location Address or GPS RequiredRow5_4: OccupancyRow5_2: Sq FtRow5_2: Year BuiltRow5_2: No of StoriesRow5_2: SprinkleredRow5_2: Fire Prot ClassRow5_2: Construction CodeRow5: Valuation CodeRow5_5: Building ValueRow5_2: Contents ValueRow5_2: Computer Equipment ValueRow5_2: Underground Pipes ValueRow5_2: Not Otherwise Classified ValueRow5_2: LocRow6_2: Location Address or GPS RequiredRow6_4: OccupancyRow6_2: Sq FtRow6_2: Year BuiltRow6_2: No of StoriesRow6_2: SprinkleredRow6_2: Fire Prot ClassRow6_2: Construction CodeRow6: Valuation CodeRow6_5: Building ValueRow6_2: Contents ValueRow6_2: Computer Equipment ValueRow6_2: Underground Pipes ValueRow6_2: Not Otherwise Classified ValueRow6_2: LocRow7_2: Location Address or GPS RequiredRow7_4: OccupancyRow7_2: Sq FtRow7_2: Year BuiltRow7_2: No of StoriesRow7_2: SprinkleredRow7_2: Fire Prot ClassRow7_2: Construction CodeRow7: Valuation CodeRow7_5: Building ValueRow7_2: Contents ValueRow7_2: Computer Equipment ValueRow7_2: Underground Pipes ValueRow7_2: Not Otherwise Classified ValueRow7_2: LocRow8_2: Location Address or GPS RequiredRow8_4: OccupancyRow8_2: Sq FtRow8_2: Year BuiltRow8_2: No of StoriesRow8_2: SprinkleredRow8_2: Fire Prot ClassRow8_2: Construction CodeRow8: Valuation CodeRow8_5: Building ValueRow8_2: Contents ValueRow8_2: Computer Equipment ValueRow8_2: Underground Pipes ValueRow8_2: Not Otherwise Classified ValueRow8_2: LocRow9_2: Location Address or GPS RequiredRow9_3: OccupancyRow9_2: Sq FtRow9_2: Year BuiltRow9_2: No of StoriesRow9_2: SprinkleredRow9_2: Fire Prot ClassRow9_2: Construction CodeRow9: Valuation CodeRow9_5: Building ValueRow9_2: Contents ValueRow9_2: Computer Equipment ValueRow9_2: Underground Pipes ValueRow9_2: Not Otherwise Classified ValueRow9_2: LocRow10_2: Location Address or GPS RequiredRow10_2: OccupancyRow10_2: Sq FtRow10_2: Year BuiltRow10_2: No of StoriesRow10_2: SprinkleredRow10_2: Fire Prot ClassRow10_2: Construction CodeRow10: Valuation CodeRow10_5: Building ValueRow10_2: Contents ValueRow10_2: Computer Equipment ValueRow10_2: Underground Pipes ValueRow10_2: Not Otherwise Classified ValueRow10_2: LocRow11_2: Location Address or GPS RequiredRow11_2: OccupancyRow11_2: Sq FtRow11_2: Year BuiltRow11_2: No of StoriesRow11_2: SprinkleredRow11_2: Fire Prot ClassRow11_2: Construction CodeRow11: Valuation CodeRow11_5: Building ValueRow11_2: Contents ValueRow11_2: Computer Equipment ValueRow11_2: Underground Pipes ValueRow11_2: Not Otherwise Classified ValueRow11_2: LocRow12: Location Address or GPS RequiredRow12: OccupancyRow12: Sq FtRow12: Year BuiltRow12: No of StoriesRow12: SprinkleredRow12: Fire Prot ClassRow12: Construction CodeRow12: Valuation CodeRow12_4: Building ValueRow12: Contents ValueRow12: Computer Equipment ValueRow12: Underground Pipes ValueRow12: Not Otherwise Classified ValueRow12: LocRow13: Location Address or GPS RequiredRow13: OccupancyRow13: Sq FtRow13: Year BuiltRow13: No of StoriesRow13: SprinkleredRow13: Fire Prot ClassRow13: Construction CodeRow13: Valuation CodeRow13_4: Building ValueRow13: Contents ValueRow13: Computer Equipment ValueRow13: Underground Pipes ValueRow13: Not Otherwise Classified ValueRow13: LocRow14: Location Address or GPS RequiredRow14: OccupancyRow14: Sq FtRow14: Year BuiltRow14: No of StoriesRow14: SprinkleredRow14: Fire Prot ClassRow14: Construction CodeRow14: Valuation CodeRow14_4: Building ValueRow14: Contents ValueRow14: Computer Equipment ValueRow14: Underground Pipes ValueRow14: Not Otherwise Classified ValueRow14: LocRow15: Location Address or GPS RequiredRow15: OccupancyRow15: Sq FtRow15: Year BuiltRow15: No of StoriesRow15: SprinkleredRow15: Fire Prot ClassRow15: Construction CodeRow15: Valuation CodeRow15_3: Building ValueRow15: Contents ValueRow15: Computer Equipment ValueRow15: Underground Pipes ValueRow15: Not Otherwise Classified ValueRow15: LocRow16: Location Address or GPS RequiredRow16: OccupancyRow16: Sq FtRow16: Year BuiltRow16: No of StoriesRow16: SprinkleredRow16: Fire Prot ClassRow16: Construction CodeRow16: Valuation CodeRow16_3: Building ValueRow16: Contents ValueRow16: Computer Equipment ValueRow16: Underground Pipes ValueRow16: Not Otherwise Classified ValueRow16: LocRow17: Location Address or GPS RequiredRow17: OccupancyRow17: Sq FtRow17: Year BuiltRow17: No of StoriesRow17: SprinkleredRow17: Fire Prot ClassRow17: Construction CodeRow17: Valuation CodeRow17_3: Building ValueRow17: Contents ValueRow17: Computer Equipment ValueRow17: Underground Pipes ValueRow17: Not Otherwise Classified ValueRow17: LocRow18: Location Address or GPS RequiredRow18: OccupancyRow18: Sq FtRow18: Year BuiltRow18: No of StoriesRow18: SprinkleredRow18: Fire Prot ClassRow18: Construction CodeRow18: Valuation CodeRow18_3: Building ValueRow18: Contents ValueRow18: Computer Equipment ValueRow18: Underground Pipes ValueRow18: Not Otherwise Classified ValueRow18: LocRow19: Location Address or GPS RequiredRow19: OccupancyRow19: Sq FtRow19: Year BuiltRow19: No of StoriesRow19: SprinkleredRow19: Fire Prot ClassRow19: Construction CodeRow19: Valuation CodeRow19_2: Building ValueRow19: Contents ValueRow19: Computer Equipment ValueRow19: Underground Pipes ValueRow19: Not Otherwise Classified ValueRow19: LocRow20: Location Address or GPS RequiredRow20: OccupancyRow20: Sq FtRow20: Year BuiltRow20: No of StoriesRow20: SprinkleredRow20: Fire Prot ClassRow20: Construction CodeRow20: Valuation CodeRow20_2: Building ValueRow20: Contents ValueRow20: Computer Equipment ValueRow20: Underground Pipes ValueRow20: Not Otherwise Classified ValueRow20: LocRow21: Location Address or GPS RequiredRow21: OccupancyRow21: Sq FtRow21: Year BuiltRow21: No of StoriesRow21: SprinkleredRow21: Fire Prot ClassRow21: Construction CodeRow21: Valuation CodeRow21_2: Building ValueRow21: Contents ValueRow21: Computer Equipment ValueRow21: Underground Pipes ValueRow21: Not Otherwise Classified ValueRow21: LocRow22: Location Address or GPS RequiredRow22: OccupancyRow22: Sq FtRow22: Year BuiltRow22: No of StoriesRow22: SprinkleredRow22: Fire Prot ClassRow22: Construction CodeRow22: Valuation CodeRow22_2: Building ValueRow22: Contents ValueRow22: Computer Equipment ValueRow22: Underground Pipes ValueRow22: Not Otherwise Classified ValueRow22: LocRow23: Location Address or GPS RequiredRow23: OccupancyRow23: Sq FtRow23: Year BuiltRow23: No of StoriesRow23: SprinkleredRow23: Fire Prot ClassRow23: Construction CodeRow23: Valuation CodeRow23_2: Building ValueRow23: Contents ValueRow23: Computer Equipment ValueRow23: Underground Pipes ValueRow23: Not Otherwise Classified ValueRow23: LocRow24: Location Address or GPS RequiredRow24: OccupancyRow24: Sq FtRow24: Year BuiltRow24: No of StoriesRow24: SprinkleredRow24: Fire Prot ClassRow24: Construction CodeRow24: Valuation CodeRow24_2: Building ValueRow24: Contents ValueRow24: Computer Equipment ValueRow24: Underground Pipes ValueRow24: Not Otherwise Classified ValueRow24: LocRow25: Location Address or GPS RequiredRow25: OccupancyRow25: Sq FtRow25: Year BuiltRow25: No of StoriesRow25: SprinkleredRow25: Fire Prot ClassRow25: Construction CodeRow25: Valuation CodeRow25_2: Building ValueRow25: Contents ValueRow25: Computer Equipment ValueRow25: Underground Pipes ValueRow25: Not Otherwise Classified ValueRow25: LocRow26: Location Address or GPS RequiredRow26: OccupancyRow26: Sq FtRow26: Year BuiltRow26: No of StoriesRow26: SprinkleredRow26: Fire Prot ClassRow26: Construction CodeRow26: Valuation CodeRow26_2: Building ValueRow26: Contents ValueRow26: Computer Equipment ValueRow26: Underground Pipes ValueRow26: Not Otherwise Classified ValueRow26: Name: 1Mailing address: 1Yes: Off1No: Off2Yes: Off2No: OffYes: OffNo: OffRetrospective Date: 3Yes: Off3No: Off1Coverage limit: 2Auto Liability deductible if any: 2Auto Liability premium: 2Comprehensive CollisionAuto Physical Damage premium: 2Comprehensive CollisionCoverage limit: 4Yes: Off4No: Off2Comprehensive Dedutctible: 2Collision Deductible: 3Deductible: 3Earthquake coverage: 3Flood coverage: 3Loss of Income limit: 3Annual: Off3Multi-Year: Off4Annual: Off5Yes: Off6Yes: Off6No: Off5No: Off4Multi-Year: Off7Yes: Off7No: Off5Annual: Off5Multi-Year: Off6Limits Each OccurrenceAggregate: 6Claims-made: Off6Occurrence: Off7Limits Each Occurrence Aggregate: 7Coverage Types liability first party expenses etc: 7Claimsmade_2: Off7Occurrence_2: Off2If Claims-Made - Retroactive Date: If Claims-Made - Retroactive Date: 2If a Metropolitan district what services are provided: 1City State Zip: 1Phone: 1Email: 1Primary Contact: 1Position: 2Name: 2Mailing address: 2City State Zip: 2Phone: 2Email: 2Primary Contact: 1Insurance company name: 1Expiration date: 1Expiring Premium: 2Insurance company name: 2Expiration date: 2Expiring Premium: 3Insurance company name: 3Expiration date: 3Expiring Premium: 4Insurance company name: 4Expiration date: 4Deductible: 4Loss of Income limit: 4Expiring Premium: 5Insurance company name: 5Expiration date: 5Deductible: 5Expiring Premium: 6Insurance company name: 6Expiration date: 6Deductible: 6Expiring Premium: 7Insurance company name: 7Expiration date: 7Deductible: 7Expiring Premium: 1Claims-Made: Off1Occurence: Off

Property & Liability A pplication - CSD Pool › wp-content › uploads › CSD-PL-Application-FINA… · Please list all district-owned property and contents (for more space, see

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