BI Additional Property (Bulk Billing) New Properties No Street * City * State * ZIP * Type of Cover * Hazard & LiabilityVacant Land Start Date * Property Type * Residential - SFHResidential - Multi FamilyCommercialVacant Land Residential is 4 or less units Sum Insured * No of Units * Sq Feet * Year Built * Year roof replaced * 2023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990 select the approximate year the roof was replaced Electrical Sys * Breakers Fuses Occupancy * Occupied Vacant Construction * BrickMasonryFrame Owner Name Owner Email Address Additional Insured plus1 Add another property minus1 Remove this property By submitting this application, I agree to be bound by the terms and conditions of Stateside APM and its insurance carriers. I agree that I will pay the additional subscription and setup costs, and cost of insuring this property from the date shown and understand it will be added to my next invoice . This property will be added to Stateside APM's master policy and billed to the portfolio under the bulk billing arrangement for "Vacant Land" can only be selected if there is no building on the property. I understand that only liability cover will be provided. The admin fee for this type of cover is $30 per month. I further agree that it is solely my responsibility as the property manager of this property to ensure that the owner is fully aware of the policy terms and conditions and that I have provided the owner with instructions how to view them. I further agree to hold harmless Stateside APM in the event that I fail to do so. Full details of the policy terms and conditions and claims procedures, together with any additional terms and conditions imposed by Stateside APM are available at www.statesideapm.com/iptc Submitted by * On Behalf of Company Date Confirmation will be sent to this email address * Confirm Confirmation will be sent to this email address * If you are human, leave this field blank. Submit Δ
