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Lighthouse Santa Cruz

CREATING PEACE OF MIND
SINCE 1964

Important: Please Complete the Form in One Sitting

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PIA Older Building Supplemental

This document will assist in providing the information required for underwriting purposes regarding the updating of critical building systems. Please provide formal documentation as required.

Electrical:

Has the electrical system been inspected by a licensed electrical contractor to validate and verify that the system is adequate for the current occupancy.
Yes
No

Statistics show that as an electrical system ages, connections may loosen and cause arcs that may lead to fire.  Over 24% of all structure

fires are caused by electrical issues. For buildings built before 1970, Sequoia requires that the electrical system be evaluated by a licensed electrician for code, safety, and/or other electrical hazards.

Size of electrical service?
<100 amps
100 amps
>100 amps

Less than 100 amps may indicate improper load capacity

Type of circuit overload protection:
Circuit Breakers
Fuses

Fuses may indicate an older electrical system

Models such as Federal Pacific & Zinsco are known fire hazards

Type of Wiring:
Copper
Knob & Tube
Aluminum
Metallic Cable
NM Non-Metallic
Other

Aluminum wiring between the panel and the receptacles, switches, etc. must have the Cu/Al connectors.

Plumbing:

Type of water piping:
Copper
Steel/Iron
Polybutylene
Other Plastic

Polybutylene will fail due to the reaction of the material with the water.

HVAC:

Roofing:

Roofing system:
Asphalt /Fiberglass Composition
Clay Tile
Membrane
Built-up
Other
Who referred you to Santa Cruz Insurance:
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