Property Coverage Change Request

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- Auto Accident Claims / Incidents
- All Other Claims / Incidents
Policy Requests / Changes
Visit AHRP

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- For Public Housing Authorities
- HARRP Coverage Agreement
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HARRP
Coverages
- For Public Housing Authorities
- HARRP Coverage Agreement
Resources
Contact

Property Coverage Change

Change Property Coverage

NOTE: Due to the complexity of this form and need to upload documents, you may find it easier to input this information on a desktop computer or a larger screen.

Step 1 of 4

25%

Phone
This field is for validation purposes and should be left unchanged.
Housing Authority or Insured Entity*
Housing Authority or Insured Entity Address*
Street Address Address Line 2 City State ZIP Code
Your name*
First Last
Your email*
Phone*
Location Information
Location name
Tax ID*
Location address*
Street Address Address Line 2 City State ZIP Code
Property Manager*
If the Property Manager is not the housing authority, please attach certificates and the property management agreement (upload available at end of form).
Does the contract property manager have Errors & Omissions / Tenant Discrimination insurance?*
- YES
- NO
Is the property manager or contracted party(ies) contractually responsible for fair housing claims?*
- YES
- NO
Entity Information
Type of Entity*
- Wholly owned by housing authority
- Limited liability company or partnership (general or limited) that provides affordable housing and is affiliated* with a housing authority or nonprofit corporation that provides affordable housing
- Non-profit corporation
*Affiliated means (i) an ownership interest by the housing authority or nonprofit corporation in the partnership or LLC, (ii) the right of the housing authority or nonprofit corporation to direct management or policies of the partnership or LLC or (iii) a contract for the housing authority or nonprofit corporation to lease, manage or operate the affordable housing.
What activities other than housing is the owner involved in?*
Are you seeking insurance for these other activities?*
- YES
- NO
If a non-profit corporation, do the nonprofit and the housing authority have the same board of directors?*
- YES
- NO
Type of Unit(s)
- Senior
- Family
- HOA / Condo
- Single-Room-Occupancy
- Group Home
- Assisted Living / Disabled
- Supportive Housing
- Other
Please describe services*
Insurance Information
Policies Requested*
- Liability & Property
- Liability Only
- Liability Only (During Construction)
- Property only
Proposed effective date*
MM slash DD slash YYYY
Current deductible*
General liability limits*
Excess*

Building / Structure Information
Building*
Street Address Address Line 2 City State ZIP Code
Year built*
# of Stories*
# of Dwelling Units*
# of Non-dwelling Units*
Building Sq Ft.*
Building Structure Value*
Building Contents Value*
Annual Building Rents*

Total structure value*
Value per square foot*
Dwelling type*
- Apartments
- Condos
- Duplex
- Triplex
Are there NON-cosmetic repairs needed?*
- YES
- NO
Describe non-cosmetic repairs that are necessary:
Is the structure currently occupied?*
- YES
- NO
Is the property on historical register?*
- YES
- NO
Construction Type*
- Wood
- Fire Resistant
- Joisted Masonry
Roof Type*
- Composit
- Metal
- Clay / Concrete Tiles
- Asphalt Shingles
- Stone-coated Steel
- Slate
- Rubber Slate
- Green Roof
- Built-up Roofing
Roof last update (year)*
Electrical last update (year)*
Plumbing last update (year)*
Heating last update (year)*
Electrical Panel Box*
- Fuses
- Circuit Breakers
Smoke detectors?*
- YES
- NO
Sprinklers?*
- YES
- NO
Fire alarms?*
- YES
- NO
Monitored?*
- YES
- NO
Does each unit have its own breaker/fuse box?*
- YES
- NO
Management on site?*
- YES
- NO
Maintenance equipment or buildings on site?*
- YES
- NO
Playground?*
- YES
- NO
Workout room?*
- YES
- NO
If YES, are signs posted (i.e. “Use equipment at your own risk”)?
- YES
- NO
Swimming pool?**
- YES
- NO
If YES, does it have a 6’ fence & self-closing & latching gates?
- YES
- NO
Are solar panels at this location?*
- YES
- NO
If YES, what is the value?

Organizational Information
Have Fair Housing complaints, claims/orders been filed against the entity?*
- YES
- NO
Have building inspectors, the fire department, or a municipality issued building or life safety code violations, citations, or orders against the property?*
- YES
- NO
When was the last fair housing training for all staff?
MM slash DD slash YYYY
Do you provide security services?*
- YES
- NO
If YES, what type?
Are any employees required to carry a special license of any kind?*
- YES
- NO
If YES, what type?
Attach photographs of the Building/Property
If there are any supporting photographs of the building interior or exterior, please attach. (supported formats: .jpg, .jpeg, .png, .hei; 12MB max per photo)
Drop files here or

Accepted file types: jpg, jpeg, png, heic, Max. file size: 12 MB, Max. files: 25.
Attach supporting documents
If there are any supporting documents, please attach. (supported formats: .doc, .docx, .pdf)
Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 128 MB.
ELECTRONIC SIGNATURE*
- I certify that the information on the application is true and accurate to the best of my knowledge. I understand that if alternate information becomes available, it may result in a change of premium or policy/coverage cancellation. By submitting I am providing my electronic signature.
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For public entity related questions, please contact:

Rachel O'Neil

(360) 574-9384

For affordable housing related questions, please contact:

Meaghan Brown

(360) 718-5699

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Property Coverage Change

Change Property Coverage

Step 1 of 4

Location Information

Entity Information

Insurance Information

Building / Structure Information

Organizational Information

For public entity related questions, please contact:

Rachel O'Neil

For affordable housing related questions, please contact:

Meaghan Brown