Full Client Name

STATE OF HAWAII DATA REQUIREMENTS - PROPERTY

Department Name:

Address of this location:

City: State: HI Zip Code:

Please complete below per building or space you occupy. (Note: Remember to use replacement cost value and not depreciated/book value)

Building Replacement Cost: $ (if known) -OR- Allow Aon to determine using Marshall-Swift

Business Personal Property Value at this location (contents, furniture, fixtures, equipment/machinery): $

Electronic Data Processing Equipment (computer equipment including media & software): $

CONSTRUCTION (see descriptions of construction type on page 2) :

Construction Class Roof Floors Wall 1. Frame 2. Joisted Masonry 3. Non-combustible 4. Masonry non-combustible 5. Modified Fire Resistive Other (please specify)

# of stories: Basement: Yes No Year Built: Total Area: sq. ft. (excl. basement) (incl. basement)

OCCUPANCY Nature of business/description of operations at this premises

Is the building owned or rented/leased? Owned Rented/Leased

If rented/leased: Is the State required to provide insurance? What is the required limit? Provide landlord name and address

Other Tenants: yes no (If yes describe)

If you occupy the basement or below-grade floor, describe operations & list equipment used.

PROTECTION Fire Extinguishers: Yes No Fire Hydrants: Yes No # of within 500 Feet: Closest Fire Station: miles

Fire Alarm: Yes ( Central Station or Local Gong) No Fire Alarm Manufacturer:

State of Hawaii Data Call-Property Page 1 rev. 4-2007 STATE OF HAWAII DATA REQUIREMENTS - PROPERTY

Automatic Sprinklers: Yes No Burglar Alarm: Yes; Type No

Watch Service: Yes No Supervised: Yes No

Describe any other fire protection features such as a large body of water nearby that can be used by Fire Department, pumpers, etc.

EXPOSURES Distance to nearest neighboring buildings: North ft. Occupancy South ft. Occupancy East ft. Occupancy West ft. Occupancy

Loss Experience (other than Flood) Give details and amounts

Has there been a flood of this property? Yes No If yes, give details & amounts:

Flood Exposure (nearest body of water/distance): miles

*STANDARD CONSTRUCTION DEFINITIONS

The following definitions apply to all causes of loss other than Earthquake:

Frame - Buildings where the exterior walls are wood or other combustible materials including construction where combustible materials are combined with other materials such as brick veneer, stone veneer, wood iron-clad, stucco on wood.

Joisted Masonry - Buildings where the exterior walls are constructed of masonry materials such as adobe, brick, concrete, gypsum block, hollow concrete block, stone, tile or similar materials and where the floors and roof are combustible.

Non-Combustible - Buildings where the exterior walls and the floors and roof are constructed of, and supported by metal, asbestos, gypsum or other non-combustible materials.

Masonry Non-Combustible - Buildings where the exterior walls are constructed of masonry materials as described in Code 2 above, with the floors and roof of metal or other non-combustible materials.

Modified Fire Resistive - Buildings where the exterior walls and the floors and roof are constructed of masonry or fire resistive material with a fire resistance rating of one hour or more but less than two hours.

The information is completed by (print name): Date:

Signature: Title:

Phone No: Fax No:

E-mail:

State of Hawaii Data Call-Property Page 2 rev. 4-2007