Self Storage Program Questionnaire

Self Storage Program Questionnaire

Ponderosa Insurance Agency, LLC 
Post Office Box 21747
Phoenix, AZ   85004
Fax: 602-745-6413

For a quick premium indication, please submit this form to us.

Facility
Name of Storage Facility
Address
City
State	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
ZIP Code
County
Contact
Contact Name
Daytime Phone
Fax
E-Mail
Replacement Cost Value
Building	$
Contents	$
Total Number of Buildings
Total Number of Self Storage Buildings
Total Square Footage All Buildings	Ft2
Construction Type
If mixed construction, advise as to percentage of Frame, Masonry, Metal	% Frame          % Masonry        % Metal           % Fire Resistive
Number of Floors
Has elevators	YesNo
Year Built
Was building constructed for storage?	YesNo
Number of Storage Units
Number of Climate Control Units
Number of Open Lot Storage Spaces (RV/Autos)
Site Protection
Distance to Fire Hydrant	Ft.
Alarm Type
Is Fenced	YesNo
Type of Fence
Electronic Gate	YesNo
Has Sprinklers	YesNo
Management Experience
Is owner/manager a member of a Storage Association?	YesNo
Number of years ownership experience
Is the office on the premises?	YesNo
Is resident manager on premises?	YesNo
Is there any other business on premises?	YesNo
Describe other business on premises
Signature
The preceding information is true and accurate to the best of my knowledge	Type your full name