COMPANY DETAILS

Named Insured

Mailing Address

City State ZIP Code County

Contact Name Phone Fax

Email Website

Prior Carrier Expiring Premium

SELF-STORAGE SUPPLEMENTAL APPLICATION

Please complete this form and also provide the following:

- Statement of Values - 5 Years of Loss History

- Income Statement or P&C Statement

Business Property – Buildings $

Business Personal Property $

$

$

Deductible

Loss of Rental Income & Extra Expense

COVERAGE

SECTION I - BUSINESS PROPERTY (Blanket Building & BPP Coverage at Each Location)

page 1

DBA

Employee Dishonesty

Employee Property ($10,000 included)

Fine Arts ($10,000 included)

Valuable Papers and Records ($25,000 included)

Accounts Receivable ($25,000 included)

Limited Pollutant Removal (supplemental application required)

Mini-Computer Coverage ($20,000 included)

Pollution Clean-up & Removal ($25,000 included)

Equipment Breakdown

Business Income (15 months actual loss sustained included)

Extended Business Income (180 days included)

OPTIONAL COVERAGES

180 days

See Supplemental Application

Effective Date

Location Address*

City State ZIP Code County*If more than 2 locations, please complete the Citadel SOV.

Inspection Contact Phone Number

Employee’s Practices Liability (supplemental application required)

Employee Personal Liability

OPTIONAL COVERAGES

Vacant Land # of acres

Incidential Occupancies # of stalls

Lessor’s Risk Only Square Feet

Employee Benefit Liability # of employees Are all employee benefits programs in writing? Yes No

page 2

See Supplemental Application

SECTION II – BUSINESS LIABILITY

Comprehensive Business Liability

Liability and Medical Limit

Medical Expenses (includes $10,000 per person)

Hired Non-owned Auto (included at no charge)

Customer's Goods-Legal Liability

Sales & Disposal (includes $10,000 / $1,000 deductible applies)

$1,000,000

MORTGAGEE / LOSS PAYEE / ADDITIONAL INSURED DETAILS

Mailing Address

City State ZIP Code

Mortgagee Loss Payee Additional Insured

Name

Name

Mailing Address

City State ZIP Code

Mortgagee Loss Payee Additional Insured

If more space is needed, please attach a list.

SELF-STORAGE OPERATIONS

Does owner act as manager? Yes No

Years of experience in self-storage industry (years) Other business experience (years)

Gross annual sales $

Is rental o�ce on premises? Yes No If no, complete physical address

Was facility originally designed for self-storage? Yes No

If no, complete the converted building supplemental application. Inspection will be required if coverage is bound.

Are any tenants conducting non-storage operations on the premises? Yes No

If yes, describe the operations including the building used and the square footage occupied:

If yes, provide a copy of the lease used for the commercial LRO tenants and Evidence of Ins. with our insured as AI is required to bind.

Does the Named Insured have any business activities other than self-storage operations occurring on the premises?

Mailbox Rentals Yes No

Vault Style Rentals Yes No

Truck/Trailer Rentals Yes No

If yes, name of company

Record Storage/Management Yes No

Wine Storage Yes No

Other (describe)

Are forklifts or loaders used? Yes No

Are elevator lifts used?

Are padlocks sold at rental o�ce? Yes No

Are duplicate keys retained? Yes No

If yes, who retains the keys?

And wind uplift classification:

Amount of Gap Between Ceiling and Partition

Climate controlled storage?

Operational fire sprinkler system?

Occupancy Rate

LOCATION # LOCATION # LOCATION # LOCATION # LOCATION # LOCATION #

SELF STORAGE PREMISE PROTECTION

(Ordinary, Semi-Wind Resistive,Wind Resistive)

Number of units:

Self-storage buildings:

Non Self-storage buildings:

Year constructed:

Distance between buildings:

Total area (gross square feet):

Number of stories:

Construction material:

Exterior walls:

Joisting:

Interior partitions:

Roof:

If metal, state gauge thickness:

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

page 3

Yes No

Total Open Lot Total Open Lot Total Open Lot Total Open Lot Total Open Lot Total Open Lot

SELF STORAGE BUILDING DETAIL INFORMATION

Exterior Cladding Type (indicate majority type by number listed below)

1 - Reinforced Masonry/Concrete (steel reinforced masonry blocks/Pre‐cast or cast in place concrete walls)2 - Unreinforced Masonry 3 ‐ Brick Veneer 4 ‐ Metal Sheathing 5 - Wood (Wood panels or lattices)7 ‐ Laminated Glass (Glass with a plastic laminate covering)8 ‐ Non‐Protected Glass (Large glass windows using non‐laminate glass, such as store fronts and bay windows)

Are Roofs Strapped

Roof Covering (indicate type by number listed below)

1 ‐ Concrete Fill ‐any concrete slab or plate installed on a roof framework or surface, e.g. high‐rise buildings 2 ‐ Metal Sheathing ‐deck roofing made of corrugated metal sheets or otherwise shaped metal sheets3 ‐ Single Ply Membrane 4 ‐ Asphalt Shingle5 ‐ Concrete/Clay Tiles 6 ‐ Other ‐ please describe in detail

Roof Pitch

Flat 0°Low <10°Medium 10° to 30°High >30°

Protection of Openings ‐ Windows

Colonial Shutters Bahama Shutters Roll‐up Shutters Accordion Shutters Laminated Windows

Roof Equipment ‐ solar panels, billboards, water towers, etc

NoneSolar Panels Anchored?Billboards Anchored?Water Towers Anchored?Cell Towers Anchored?Other* Anchored?*please advise type of roof equipment

page 4

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Was Licensed Contractor used? Yes No

(submit interior and exterior photos)

Has property su�ered flood or surface

water accumulation? Yes No

If yes, explain how:

If coastal area, distance from coast:

Is facility inside city limits? Yes No

Name of servicing Fire Department:

Distance to servicing Fire Department:

Distance to Fire Hydrant:

Fire Alarms? Yes No

Connected to Central Station? Yes No

Burglar Alarms? Yes No

Connected to Central Station? Yes No

Positive ID required when Lease is signed? Yes No

Does Manager reside on premises Yes No

Does Manager check tenant’s locks Yes No

On a daily basis? Yes No

Local Police patrol? Yes No

Private patrol? Yes No

Armed security guard? Yes No

Guard Dogs? Yes No

Fully lighted at night? Yes No

Manual Sign In – Sign Out system? Yes No

Complex fully fenced or enclosed? Yes No

Type and height of fence:

Number of entries: Number of exits:

Gates visible from Manager’s o�ce? Yes No

Gate access and control system? Yes No

Locked manually? Yes No

Automated barrier arm? Yes No

Keyboard touchpad? Yes No

Card entry? Yes No

Sliding gate? Yes No

Driveway bell? Yes No

Surveillance cameras? Yes No

Are cameras monitored? Yes No

Are background checks performed on all prospective employees? Yes No

Other than the owners, who has checking signing authority?

If No, are all sites visited on a regular basis with an inspection of the books performed? Yes No

Frequency of cash/accounts audits (i.e. monthly, quarterly)?

Are audits done by someone other than employees responsible for daily accounting? Yes No

If Yes, by whom?

Is the owner actively involved in the business? Yes No

If Yes, by whom?

DESCRIPTION OF STORAGE FACILITY

EMPLOYEE DISHONESTY

page 5

Roof

Plumbing system

Heating system

Electrical system

BUILDING UPDATES / RENOVATIONS (updates completed within past 15 years)

Details Date Completed

Are state lien laws followed when reclaiming spaces?

What limitations are placed on the manager’s authority?

Number of sales of individual tenant’s property occurring within the past 12 months?

What was the total recovered from these sales?

List any small claims or Superior Court actions for the past 3 years by tenants claiming damage for sale or disposal

of their personal property in the Loss History section.

Please forward the following documentation:

• Copy of insured’s written delinquency procedures, from day 1 through sale date.

• Copy of all letters and notices mailed to tenants.

• Copy of the wording used for newspaper advertisement of the sale.

SALE AND DISPOSAL LEGAL LIABILITY

LOSS HISTORY

Date of Loss Description Amount Open/Closed

Details Below Loss Runs Attached No Losses

Applicant’s Signature Date

Applicant's Full Name Position

page 6

• Copy of complete tenant lease agreement with all addendums and rules.