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Welcome to Mullen Insurance Agency Inc.

 

 

Complete and submit this supplement along with the General Liability Quick Quote Request.

Agency Information                  

I am:

Agency Name:   

Producer Name:

Agent/Producer Phone:

        required!            Email Address:    (retail customer or agent)

Applicant Information            
Name:

DBA:
Address:  
City: Phone:
County: Fax:
State: Must be based in Texas. email:
Zip:

General Information               

Age of Bldg: # of Bldgs # Stories # Units % Occupied
Construction/Last Updated: Roof Wiring
If Over 10 years, Detail 
If Aluminum Wiring, Have all outlets been pigtailed and checked by a Licensed Elecrical Contractor within the past 5 years?

 

# years owned Condition of Property  
Surrounding Area  

Fire/Safety Information          

Hallways/Stairwells Open or Closed
Fire Doors & Panic Hardware
Is there a Central Station
If Yes, Is it monitored to desk
Type of Heat/Smoke detectors
How often are detectors tested If battery, how often are batteries replaced  
Is Risk Sprinklered
If yes, describe which areas

Swimming Pool Information     

Number of Pools
Are pools fenced from all units?
If yes, what is the height of the fence
Any structures within 10' of the edge of the pool
Is there a diving board or slide
If yes, what is the height of the board
Shepherds Hook/Ring nearby

Security Information                 

Sliding glass doors equipped with additional locks?
Do entry doors have keyless deadbolts?
Do entry doors have peepholes?
Are there any security guards on premises?
If yes, provide full details including whether armed, off-duty police, independent firm (provides certificate?) or Employees and if there is any non-cash compensation?
Are there fences and/or gates surrounding the property?
Are criminal checks done on employees?
Are criminal checks done on prospective tennants?
Have there been any previous incidents of physical or sexual assault?

Other Information                      

Confirm that lease/rental agreement makes no warranties with regard to security and that leasing
agents/employees are instructed to advise potential and current tenants to dial 9-1-1
Number of units with subsidies or government funding (HUD, rent subsidies, rent funding or other:
Describe type:  
Percent rented to   Students              Elderly
Any of the following?  Please describe all YES answers in detail below.
Baseball fields Clubhouses Restaurants
Basketball Courts Convenience Stores Saunas/Spas
Racquetball Courts Exercise Facility Security Guards
Tennis/Volleyball Courts Lakes Sewage Plants
Bathing Beaches Lifeguards Special Events
Bike/Horse Trails Parks Streets/Roads
Boat Docks/Slips Playgrounds Water Works

Details