1-4 Family Residential Structure Addition Form Single Family dwellings, duplex, triplex and 4-plex structures (1-4 family homes) Step 1 of 3 33% **All additions will be added/endorsed the date that we receive your request in our office. If you have multiple additions, complete one form per property. **Name Insured ( As Shown in policy declarations)(Required)Policy # (e.g.; EQ123, TH123, TG123)(Required)Contact Name (Form Completed by)(Required)Contact Phone Number(Required)Email Address(Required) Property InformationStructure Type(Required)SingleDuplexTriplexQuadplexOwnership Type(Required)RentalOwnerMutual HelpLow RentTenantConstruction Type(Required)FrameMasonryMasonry VeneerMobile Home (Deed/Title Required to add)Other Construction- state belowOther Construction-state belowRoof Type(Required)Built-Up Tar and GravelCorrugated AluminumCorrugated CompositionMetal, other than standing seamMetal, standing seamShingles, asphaltShingles, compositionTile, clay, SpanishTile, concrete, flatOther-state belowRoof Type-Other- State belowPhysical Shape of Home(Required)Angular (few to no right angles)ComplicatedH-ShapedI-ShapedL-ShapedRectangularRoundedSquareT-ShapedU-ShapedExterior Type/Siding(Required)Brick Veneer, face brickBrick Veneer, standardConcrete BlockMetal siding, corrugated aluminumMetal Siding, corrugated aluminum, paintedSiding, vinylStone Veneer, arizona stoneStone Veneer, limestoneStuccoOther, state belowExterior Siding- Other-State belowExterior Square Foot(Required)Number of Stories(Required)Year Built(Required)Year Roof Replaced(Required) Home Under Construction/Builders Risk(Required)YesNoContractorIf yes, estimated completion date MM slash DD slash YYYY Special UpgradesBasement(Required)NoneFinishedUnfinishedMeasurement of Decks ( L x W)Measurement of Porch ( L x W ) Project Number(Required)Unit Number(Required)Stated Building Value(Required)**Mobile Homes will be valued at stated value. All values will be reviewed and evaluated by the Underwriting Department. Physical Address(Required) Street Address City State / Province / Region ZIP / Postal Code Occupant Name(Required) First Last What is the funding source of this home?(Required)Do you (housing) hold title (deed) to this home?(Required)YesNoTrampoline on Premise?(Required)YesNoCentral Station Burglar Alarm?(Required)YesNoPool on Premise?(Required)YesNoCentral Station Fire Alarm?(Required)YesNoPHOTOS Drop files here or Select files Max. file size: 100 MB. CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Why AMERIND? Our Story Our Team Board of Directors Cell Advisory Commission AMERIND Products and Services Tribal Government & Business Tribal Workers’ Compensation Tribal Auto Program Homeowners & Renters AMERIND Critical Infrastructure Indian Housing Block Grant Cyber Liability Coverage News & Resources Latest News Newsletter Archive Upcoming Events Risk Control Resources Customer Payment Portal Property Addition and Deletion Forms and Reference Guide Find an Insurance Broker List of Non-Appointed Brokers Insurance Resources Fact-Check Trusted Voices Webinar Community Outreach Charitable Giving Scholarships, Grants & Awards RFP/Job Posting Sharing
1-4 Family Residential Structure Addition Form Single Family dwellings, duplex, triplex and 4-plex structures (1-4 family homes) Step 1 of 3 33% **All additions will be added/endorsed the date that we receive your request in our office. If you have multiple additions, complete one form per property. **Name Insured ( As Shown in policy declarations)(Required)Policy # (e.g.; EQ123, TH123, TG123)(Required)Contact Name (Form Completed by)(Required)Contact Phone Number(Required)Email Address(Required) Property InformationStructure Type(Required)SingleDuplexTriplexQuadplexOwnership Type(Required)RentalOwnerMutual HelpLow RentTenantConstruction Type(Required)FrameMasonryMasonry VeneerMobile Home (Deed/Title Required to add)Other Construction- state belowOther Construction-state belowRoof Type(Required)Built-Up Tar and GravelCorrugated AluminumCorrugated CompositionMetal, other than standing seamMetal, standing seamShingles, asphaltShingles, compositionTile, clay, SpanishTile, concrete, flatOther-state belowRoof Type-Other- State belowPhysical Shape of Home(Required)Angular (few to no right angles)ComplicatedH-ShapedI-ShapedL-ShapedRectangularRoundedSquareT-ShapedU-ShapedExterior Type/Siding(Required)Brick Veneer, face brickBrick Veneer, standardConcrete BlockMetal siding, corrugated aluminumMetal Siding, corrugated aluminum, paintedSiding, vinylStone Veneer, arizona stoneStone Veneer, limestoneStuccoOther, state belowExterior Siding- Other-State belowExterior Square Foot(Required)Number of Stories(Required)Year Built(Required)Year Roof Replaced(Required) Home Under Construction/Builders Risk(Required)YesNoContractorIf yes, estimated completion date MM slash DD slash YYYY Special UpgradesBasement(Required)NoneFinishedUnfinishedMeasurement of Decks ( L x W)Measurement of Porch ( L x W ) Project Number(Required)Unit Number(Required)Stated Building Value(Required)**Mobile Homes will be valued at stated value. All values will be reviewed and evaluated by the Underwriting Department. Physical Address(Required) Street Address City State / Province / Region ZIP / Postal Code Occupant Name(Required) First Last What is the funding source of this home?(Required)Do you (housing) hold title (deed) to this home?(Required)YesNoTrampoline on Premise?(Required)YesNoCentral Station Burglar Alarm?(Required)YesNoPool on Premise?(Required)YesNoCentral Station Fire Alarm?(Required)YesNoPHOTOS Drop files here or Select files Max. file size: 100 MB. CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.