Olympus Application Questions - Responsive Insurance

Name *

Email *

Which Responsive Insurance agent are you working with? *

Any farming or any other business conducted on the premises (including any day/child care)? *

Yes
No

Any Residence employees? *

Yes
No

Any other residence owned, occupied, or rented? *

Yes
No

Explanation *

Any coverage declined, cancelled, or nonrenewed in the last three years? *

Yes
No

Has applicant had a foreclosure, repossession, bankruptcy, judgement, or lien during the past five (5) years? *

Yes
No

Are there any exotic pets or any animals kept on the premises? *

Yes
No

Do animals have a history of biting or attacking? *

Yes
No

Are any animals classified as or a mix of one of the following breeds? Akita, American Pit Bill Terrier, American Staffordshire Terrier, Catahoula Leopard, Chow, Doberman Pinscher, Presa Canario, Pit Bull, Rottweiler, Staffordshire Bull Terrier, or Wolf? *

Yes
No

Please provide information on the animal(s) *

Is Property Situated on more than five (5) acres? *

Yes
No

Is there a fuel oil storage tank on the premises? *

Yes
No

Does applicant own any recreational vehicles (snowmobiles, dune buggies, mini bikes, ATV's, etc.)? *

Yes
No

Any uncorrected fire code violations? *

Yes
No

Is house vacant? *

Yes
No

Is property within 300 feet of a commercial or nonresidential property? *

Yes
No

Is there a trampoline on the premises? *

Yes
No

Was the structure originally built for other than a private residence and then converted? *

Yes
No

Is building under construction or renovation or reconstruction? *

Yes
No

During the last five years (5) has any applicant been indicted for or convicted of any degree of the crime of arson, fraud, or any other arson-related crime? *

Yes
No

Is house vacant? *

Yes
No

Is the dwelling currently being rented or leased? *

Yes
No

Do you anticipate the dwelling will ever be rented or leased? *

Yes
No

Is applicant a professional athlete, elected politician, or public figure of any kind? *

Yes
No

Any supplemental heating? Wall heat, stove, other? *

Yes
No

Is the home built on an open foundation? *

Yes
No

Is there a pool on the property? *

Yes
No

Does the pool have a diving board or slide? *

Yes
No

Is the pool protected by a permanently installed fence, wall, or screened enclosure that is lockable? *

Yes
No

Is the property location currently being purchased or has been purchased within the last 12 months from a foreclosure, short-sale, or otherwise bank-owned property? *

Yes
No

Is the risk constructed partially or entirely over water? *

Yes
No

Olympus Insurance Company Underwriting Questions

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