Commercial Property Profile (COPE) - Single Building Form

What is your first name?**

What is your first name?*

What is your last name?**

What is your last name?*

What is your email address?**

What is your email address?*

What is your phone number?**

What is your phone number?*

Please select the situation that is dictating the need for this information.

Please provide a brief description of the situation dictating the need for this information.

Do you own or lease the building?

Own
Lease

What is the legal name of the owner of the building?**

What is the legal name of the owner of the building?*

What is the address of the building for which you are providing information?**

What is the address of the building for which you are providing information?*

Street Address Address Line 2 City State ZIP Code

Construction

Please select this building's construction type.

Please select the building's construction type.

A - Fireproof Steel Frame
B - Reinforced Concrete/Non-Combustible
C - Masonry Construction/Wood Roof
D - All Combustible (Wood Frame)
S - Pre-engineered/Steel
U - Unknown

Please select the term that best describes the condition of the building.

Please select the term that best describes the quality of the building.

Excellent
Good
Average
Low

What construction material was used for the walls?

How old is the heating system?

What type of heating system does the building have?

Forced Air
Window Unit
Wall Unit

How old is the cooling system?

What type of cooling system does the building have?

Forced Air
Window Unit
Wall Unit

What type of fuel does the heating/AC system utilize?

Does the building have a basement?

Yes
No

Does the building have an attic/penthouse?

Yes
No

What year was the building built?

Has the building been renovated since its was built?

Yes
No
Not sure

What year was the building renovated?

What is the floor height? (In feet)

How many floors/stories does the building have?

What is the total square footage of the building?

What is the value of the building?

What is the value of the contents within the building?

Occupancy Classification

Is the building vacant?

Yes
No

What is the occupancy classification of the building?

Please provide a description of the occupancy of the building.

Protection Features

Is the building equipped with fire extinguishers?

Yes
No

Is the building's inspection current?

Yes
No

Does the building have a manual pull box fire alarm system?

Yes
No

Is the manual pull box fire alarm being monitored/supervised?

Yes
No

Does the building have sprinkler protection?

Yes
No

What percentage of the building is sprinklered?

Is the sprinkler system being monitored/supervised?

Yes
No

Does the building have smoke/heat detectors?

Yes
No

Are the smoke/heat detectors being monitored/supervised?

Yes
No

Does the building have a security system?

Yes
No

Is the security system being monitored/supervised?

Yes
No

Does the building have fire hydrants within 1,001 feet?

Yes
No

Does the building have a fire department within five miles?

Yes
No

Exposures

Is the building located in a severe hazard flood zone? (I.e. A, V, etc.)

Yes
No

Is the building located in a high wind prone area? (I.e. coastal)

Yes
No

Does the building have any special hazards that could impact it? (I.e. Earthquake, etc.)

Yes
No

Please provide a brief description of the special hazards that could impact this building.

Please select the term that best describes this building's exposure to risk of physical damage.

Low
Moderate
Severe

Documents and Comments

Please use this field to upload any relevant insurance documents.

Drop files here or

Max. file size: 128 MB, Max. files: 10.

Please enter any additional remarks in the space below.

<font size="2" color="gray">Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.*

Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.

Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.

I agree*

Commercial Property Profile (COPE) - Single Building Form

Construction

Occupancy Classification

Protection Features

Exposures

Documents and Comments

Margaret Ann Pyburn

RiskRevu^TM Newsletter

Contact

Commercial Property Profile (COPE) - Single Building Form

Construction

Occupancy Classification

Protection Features

Exposures

Documents and Comments

Margaret Ann Pyburn

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RiskRevuTM Newsletter

Contact

RiskRevu^TM Newsletter