Storage Facility Worksheet PhoneThis field is for validation purposes and should be left unchanged.STORAGE FACILITY WORKSHEET If you have more than one facility, please use a copy of this sheet as necessary. Section A: General Information NamePhysical Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Year ConstructedSquare FeetNumber of vehicles stored at this locationNumber of vehicles facility can safely storeTotal value of vehicles at this locationHow long have vehicles been garaged here?Is the building Owned Leased Is the building Commercial Residential Is the building a multi-tenant building (any other adjoining businesses)? Yes No If yes, please describeIs there any restoration work being done on the premises? Yes No If yes, please describeSecurity Protection: (check all that apply) Central Station Burglar Alarm(monitored outside facility) Local Burglar Alarm (only on premises) No Burglar Alarm Surveillance Cameras 24 Hour On-Premise Security Padlocks or Deadbolts Fenced/Gated Property Watchdog on Premises Other OtherBuilding Construction Walls Wood Frame Steel Frame Masonry Other OtherRoof Wood Frame Steel Frame Masonry Other OtherFloor Concrete Wood Tile Other OtherClimate Heat Air Conditioning Number of storiesFire Protection: (check all that apply)Fire Alarm Central Station (monitored outside facility) Local Alarm (alarm sounds only on premises) No Alarm Central Station CompanyOther Fire Extinguishers Sprinkler System: Inspection Date Local Burglar Alarm (only on premises) No Burglar Alarm Padlocks or Deadbolts Other OtherSection B: Flood/Hurricane Exposure Please complete if your vehicles are stored in FL, GA, MS, LA, SC, TX, NC, VA, DE, NJ, NY, CT, RI, ME, AL, HI or MD.How far is your location from the coast (ocean or gulf)?In MilesHas the storage location ever had any flood or wind retrofitting? Yes No If yes, please describeYear CompletedHave you ever had any flood related claims on the building or its contents?: Yes No If yes, please describeIs there a hurricane evacuation plan in place for the vehicles?: Yes No How would vehicles be moved in the event of an evacuation? Trailered Self-Driven Other OtherAddress vehicles would be moved to Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Description of address and its safety & security featuresSection C: Earthquake Exposure Please complete if your vehicles are stored in CA, NV, OR, AZ, IL, KY, MO, IN, AR, AK, HI or WA.Has the storage location ever had any retrofitting or any other wall bracing? Yes No If yes, please describeYear completedHave you ever had any earthquake related claims on the building or its contents? Yes No If yes, please describe
