Property Manager Board of Directors Commercial Owner Residential Owner Commercial Tenant Residential Tenant
Condos, Townhomes & Apartments Shopping Centers Hotels & Motels Other Areas of Expertise D&O / Professional Liability


Hotel / Motel Supplement Application

Premises Address:
City: State: Zip:   Phone:


Coastal/Waterfront Exposure? Yes No
Distance to Ocean? ft.  
Located in 1st Tier Wind Area? Yes No  
Eligible for Windpool? Yes No  
Is Risk Located Within City Limits? Yes No
Is Risk Located in an Urban/Downtown Area? Yes No  
Responding Fire Department:
Distance to Nearest: Fire Dept



Roof Covering: Tile Asphalt Shingles Tar & Gravel Other
Building Construction: Frame Joist Masonry Non-Comb Masonry Non-Comb Mod Fire Resistive Fire Resistive

Number of Buildings:
Bldg. #1
Bldg. #2
Bldg. #3
Bldg. #4
Bldg. #5
Bldg. #6
Bldg. #7
Bldg. #8
Year Built:
Distance Between Buildings:
Number of Rooms in Building:
Number of Stories in Building:
Number of Elevators:
Total Square Footage:
Ground Floor Square Footage:
Basement Square Footage:
Percent of Building with Sprinklers:
Central Air Conditioning?


Is the Hotel/Motel the Sole Building Occupant? Yes No
Are There Smoke Detectors in Each Unit? Yes No
Clearly Marked Fire Exits? Yes No
Emergency Lighting in Common Areas? Yes No
Do All Bathtubs have Non-Slip Surfaces AND Grab Bars? Yes No
Type of Lock on Guestrooms? Electonic Key
Do Guestroom Doors also Have Deadbolt Locks? Yes No
Do Guestroom Doors have Peepholes? Yes No
Guestrooms Open to: Interior Hallway Outside
Alarm Type: Local Burglary Local Fire Central Station Burglary Alarm
Central Station Fire Alarm No Alarm
Is Premises Covered by Security Cameras? Yes No
Is There a Night Security Window for the Front Desk? Yes No
Is There a Parking Lot Located on Premises? Yes No
If Yes, is the Parking Lot Owned, Operated and Maintained by Applicant? Yes No
What is Parking Lot Square Footage? ft2


Business Information


Is Applicant Currently Open for Business? Yes No
Is the Hotel/Motel Open 12 Months Per Year? Yes No (If No, number of months per year)
Is the Hotel/Motel a Franchise Operation? Yes No
Who Manages the Hotel/Motel? Owner Operated Hired Management
Does the Manager Have 5 or More Years Management Experience? Yes No
Year Experience of Ownership at This Location? Total Years Experience in This Industry
Has Applicant Owned Premises for 3 or More Years? Yes No If No, please supply any prior ownership information:
Name and Address of Other Hotel/Motel

Time Period Owned From: To:
Any Prior Bankruptcies or Liquidations? Yes No

Are there any Losses Within the Last 5 Years? Yes No
Has Applicant Had Insurance Cancelled or Non-Renewed in the Past 3 Years? Yes No
If Yes Explain:
Total sales from lodging? $ Total sales from restaurant: Restaurant $ Liquor $
Total Number of Guestrooms Average Room Rate $ Average Occupancy Rate %
Does Anyone Except Owner/Management Live on Site Yes No
If Yes, Explain:
Are Employee Background Checks Performed? Yes No
Number of Employees Full Time: Part Time
Do Employees Have Written Guidelines to Follow? Yes No
Upon Check-In, Do Employees Copy the Guest's Drivers License? Yes No
Does Applicant Use Security Guards? Yes No
If Yes, Employees, Contract Service
Are Security Guards Armed? Yes No

Swimming Pool

Are There any Swimming Pools? Yes No If Yes, How Many? Outdoor Indoor
Are There any Hot Tubs Yes No If Yes, Is There an Automatic Shutoff for Hot Tub? Yes No
Are the Pools for Guests Only? Yes No
Are Pools Fenced with a Self-Closing and Self-Latching Gate? Yes No
Are Pools Enclosed by a Courtyard or Building? Yes No
Are Depths Clearly Marked on Top and Sides of Pool? Yes No
Is Rescue Equipment Available Poolside Including a Ring Buoy, Shepard's Hook or Pole? Yes No
Are There Diving Boards or Slides? Yes No How Many of Each?
Are There Life Guards on Duty? Yes No
If No, is Access Key Controlled to Guests Only? Yes No
Does Pool Have Video Surveillance From Front Desk? Yes No
Are Water Motion Detectors Used When Pool is Closed? Yes No
Is Pool Water Tested Daily? Yes No if No, How Often
Are Pool Chemicals Properly Stored? Yes No

Commercial Auto

Does Applicant Have any Owned Commercial Autos? Yes No if Yes, Please Write HNOA on Applicant's Auto Policy.
Is There a Valet Service? Yes No If Yes, Employee or Contracted
Is There a Shuttle Service for Guests? Yes No If Yes, Employee or Contracted
If Valet or Shuttle Services are Contracted, Does the Applicant Have a Certificate of Insurance for the Service Naming the Applicant as Additional Insured? Yes No

Leisure Facilities

Does Premises Have Playground? Yes No Ground Surface Composition
Fenced? Yes No Open to Guests Only? Yes No Rules Posted? Yes No
 Does Premises Have Fitness Center? Yes No Door Locked at All Times? Yes No
 Restricted to Adults? Yes No
 Open to Guests Only? Yes No
 Freeweights? Yes No
 Rules Posted? Yes No
 Check any Amenitities Offered: Spa Sauna Golf Tennis Basketball Racquetball Lakes/Ponds Beaches
Boat Slips Boating Surfboards Jet Skis/Wave Runners Boogie Boards Parasailing Gymnastic Facilities
Trampoline Skiiing Horseback Riding Other (describe)
Restaurant/Lounge/Mercantile Facilities
Are There any Mercantile Operations in Building? Yes No

If Leased to Others, what is the Square Footage of Leased Area? ft2

If Mercantile Operation is Leased to Others Attach Our Lessor’s Risk Supplemental
Are There any Restaurant/Lounge Operations in Building? Yes No If yes, Owner Operated or Leased to Others

If Leased to Others, What is the Square Footage of Leased Area? ft2

If Restaurant/Lounge Operation is Leased to Others Attach our Lessor’s Risk Supplemental

If Restauran/tLounge Operation is Owner Operated Attach our Restaurant/Tavern Supplemental

Applicant's Statement
I hereby apply for a policy of insurance as set forth in this application, and I certify that all of the information provided by me in this application is true and complete. I understand that any policy, which may be issued by the Company, will be issued on the basis of, and in reliance upon, my statements in this application, and that any material misrepresentation made by me may affect the payment of claims. Any person who knowingly and with intent to injure, defraud, or deceive any insurer, files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a crime. This application is not a binder, and nothing herein contained shall be construed as an agreement to provide insurance of any kind.
Signature of Applicant Date
I hereby warrant that all information contained in this application is correct and complete to the best of my knowledge

Forms by Dime Store Designs