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WHO WE ARE
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HOA
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Homeowners Association/ Townhome
Association/ Condominium Association
Single Family HOA Application
Named Insured
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Physical Address
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County
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City
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State
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Zip Code
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Mailing Address:
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City
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State
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Zip Code
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Effective Date
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Date Format: MM slash DD slash YYYY
Expiration Date
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Date Format: MM slash DD slash YYYY
Contact Name
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Telephone
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Management Company Name
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Federal Employers Identification Number (FEIN)
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Total Number of Lots at Build-Out (Improved & Unimproved)
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Completed Number of Homes
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Year Property was Built
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Date Completed
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Date Format: MM slash DD slash YYYY
Please list any Additional Insureds
General Information
Does your HOA comply with all City and State ordinances? (i.e. pools, playground equipment, postings/safety equipment, fire extinguishers, etc)?
Yes
No
Is it a Gated Community?
Yes
No
Any Water Work/Sewage Treatment/Disposal Facilities?
Yes
No
Security
Insured Does not Have Security Guards
Not Applicable
Any Security Guards on Premises?
Yes
No
If yes, are they Armed?
Yes
No
If yes, How Many?
Roads
Insured Not Responsible for any Roads
Not Applicable
Association Maintained Roads?
Yes
No
Road Maintenance Agreement with the City?
Yes
No
Number of Miles
Biking or Walking Trails
Insured Does Not Have Biking or Walking Trails
Not Applicable
Does the Association Have any Biking or Walking Trails?
Yes
No
Number of Miles
Parks
Insured Does Not Have any Parks
Not Applicable
Do You Have any Parks?
Yes
No
How Many Parks?
Swimming Pools
Insured Does Not Have a Pool
Not Applicable
How Many Pools?
Are There Lifeguards?
Yes
No
Are there any other water features, such as “lazy rivers”, wave pools, water parks, etc?
Yes
No
Do you Sponsor a Swim Team?
Yes
No
Is There a Self-Closing Gate?
Yes
No
Lakes or Ponds
Insured Does Not Have a Lake or Pond
Not Applicable
How Many Lakes or Ponds?
Is Boating Allowed?
Yes
No
Is Fishing Allowed?
Yes
No
Is Swimming Allowed?
Yes
No
Are Signs Posted?
Yes
No
Are There any of the Following Exposures?
Docks
Piers
Marinas
Dams
Beaches
Boat Slips
Watercraft
If yes, Please Provide Details
Other Amenities
Are there any additional amenities such as golf courses, tennis courts, stables, etc.?
Yes
No
If yes, list here
Property Coverage Desired (Please indicate 100% Replacement Cost)
Please indicate which items you wish to have property insurance: Examples include: Amenity Center, Buildings, Fences, Monuments, Entrance Structures, Fountains, Gazebos/Pavilions, Signs, Gates, Etc. (Click on the + sign to add more lines)
Item
Amount $
For any buildings and/or amenity centers please list year built and square footage:
Year Built
Sq. Footage
Total Property Limit $
Additional Coverages
DIRECTORS & OFFICERS
Do you Want a Quote for Directors & Officers?
Yes
No
Is There a Positive Fund balance?
Yes
No
Have you Carried Directors & Officers Before?
Yes
No
Number of developer controlled board seats
Any Past Directors & Officers Claims?
Yes
No
Number of Board Members
CRIME COVERAGE
Do you want a quote for crime (employee dishonesty)?
Yes
No
Limits (Higher limits available upon request)
$25,000
$50,000
$100,000
Deductible
$250
$500
$1,000
Other
UMBRELLA
Do you want a quote for Umbrella?
Yes
No
Limit Requested 1M – 5M (Higher limits available upon request)
WORKERS COMPENSATION
Do you want a quote for Workers Compensation?
Yes
No
How many association employees?
NON-OWNED AUTO COVERAGE
Do you want hired and non-owned auto coverage?
Yes
No
Separate Policy or include HNO in GL Limits?
CLAIM HISTORY
Has the association had any losses/claims in the past 5 years?
Yes
No
If yes, please provide details
Additional Information
THE FOLLOWING ITEMS WILL REQUIRE REFERRAL
Associations Incorporated as a City
Golf course exposure owned, operated or maintained
Associations with fire department
Recreational use of lakes
I have reviewed and made any necessary changes to this questionnaire.
Sign
*
Date
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Date Format: MM slash DD slash YYYY
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Phone: (972) 864-0400 | (888) 895-2300
Address: 3200 Broadway Blvd. Suite 400 | Garland, TX 75043
