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Agricultural Facility Report

General
Date of Inspection: *
- Month
- Day
- Year
Name of Person Interviewed: *
Title of Person Interviewed: *
- Insured
- General Manager
- Property Manager
- Building Super
- Tenant (other than the Insured)
- Other Title
List Other Title: *
Total number of buildings at location: *
Buildings present at this location: (Check ALL that apply) (If add'l bldgs are needed use the Agricultural Facility Extra Bldgs form) *
- Cotton Warehouse Building
- Cotton Warehouse Building 02
- Cotton Warehouse Building 03
- Cotton Warehouse Building 04
- Cotton Warehouse Building 05
- Cotton Warehouse Building 06
- Cotton Warehouse Building 07
- Cotton Warehouse Building 08
- Cotton Warehouse Building 09
- Cotton Warehouse Building 10
- Cotton Warehouse Building 11
- Cotton Warehouse Building 12
- Cotton Warehouse Building 13
- Cotton Warehouse Building 14
- Cotton Warehouse Building 15
- Office Building
- Shop Building
- Seed Storage Building
- Gin Processing Building
- Equipment Storage Building
- Chemical Building
- Fertilizer Building
- Other Building
- Other Building 2
- Other Building 3
- Other Building 4
- Other Building 5
- Other Building 6
- Other Building 7
- Other Building 8
- Other Building 9
- Other Building 10
Name the Other Building using its Description/Occupancy: *
Name the Other Building 2 using its Description/Occupancy: *
Name the Other Building 3 using its Description/Occupancy: *
Name the Other Building 4 using its Description/Occupancy: *
Name the Other Building 5 using its Description/Occupancy: *
Name the Other Building 6 using its Description/Occupancy: *
Name the Other Building 7 using its Description/Occupancy: *
Name the Other Building 8 using its Description/Occupancy: *
Name the Other Building 9 using its Description/Occupancy: *
Name the Other Building 10 using its Description/Occupancy: *
What is the maximum number of cotton bales that can be stored in the Largest warehouse building? *
Per Bale Value: (Currently $500) *
Cotton Stock PML (Probable Maximum Loss) in dollars *
General Comments: *
Losses
Are there prior losses? *
- Yes
- No
Describe prior losses; loss trends; status of repairs; and any corrective measures to prevent further loss. *
Operations
How long has the Insured been in business? *
How many years of experience does the owner/manger have in this industry? *
Building Interest: *
- Owned
- Leased
Number of Employees: *
Hours of Operation: *
Besides the Insured, are there any other occupants or operations? *
- Yes
- No
List each occupant: *
Does the Insured own any of the cotton bales stored at this location? *
- Yes
- No
Percentage of stored cotton bales that are owned by the insured: *
Operations Comments: (Include a description of the operations at this location) *
Office Building
*
- OFFICE BUILDING
Occupancies in this building: *
- Main Operations Office
- Other
List Other occupancy: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Office Building Comments: *
Shop Building
*
- SHOP BUILDING
Occupancies in this building: *
- Shop
- Main Operations Office
- Other
List Other occupancy: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Shop Building Comments: *
Equipment Storage Building
*
- EQUIPMENT STORAGE BUILDING
Occupancies in this building: *
- Equipment Storage
- Main Operations Office
- Other
List Other occupancy: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Please list the equipment stored within this building: *
Equipment Storage Building Comments: *
Seed Storage Building
*
- SEED STORAGE BUILDING
Occupancies in this building: *
- Seed Storage
- Main Operations Office
- Other
List Other occupancy: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Are there an adequate number of Fire Extinguishers provided? *
- Yes
- No
Extinguisher Service Tags: *
- Current (within 1 year)
- Expired (Over 1 year)
- No Tags
Extinguisher Tag Date: *
- Month
- Day
- Year
Properly Mounted: *
- Yes
- No
Describe Extinguisher Deficiencies: *
Posted No Smoking Signs? *
- Yes
- No
Seed Storage Building Comments: *
Gin Processing Building
*
- GIN PROCESSING BUILDING
Occupancies in this building: *
- Gin Processing
- Main Operations Office
- Other
List Other occupancy: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Is the Ginning equipment well maintained and in good condition? *
- Yes
- No
Describe condition or maintenance issues with the gin equipment : *
Is the Gin equipment protected by an automatic fire suppression system? *
- Yes
- No
Suppresion System Service Tags: *
- Current (within 1 year)
- Expired (Over 1 year)
- No Tags
Service Tag Date: *
- Month
- Day
- Year
Service Company: *
Are there an adequate number of Fire Extinguishers provided? *
- Yes
- No
Extinguisher Service Tags: *
- Current (within 1 year)
- Expired (Over 1 year)
- No Tags
Extinguisher Tag Date: *
- Month
- Day
- Year
Properly Mounted: *
- Yes
- No
Describe Extinguisher Deficiencies: *
Describe the quarantine room and quarantine practices. You must include the following: Where is the quarantine room? After a fire in the Gin, how many bales are quarantined? How long is the quarant... *
Posted No Smoking Signs? *
- Yes
- No
Gin Processing Building Comments: *
Chemical Building
*
- CHEMICAL BUILDING
Occupancies in this building: *
- Chemicals
- Main Operations Office
- Other
List Other occupancy: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Chemical Building Comments: *
Fertilizer Building
*
- FERTILIZER BUILDING
Occupancies in this building: *
- Feritilizer
- Main Operations Office
- Other
List Other occupancy: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Fertilizer Building Comments: (include how much fertilizer is stored here) *
Other Building
List the Occupancies: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Other Building Comments: (What is this bldg used for, list what is stored, and how much. Also indicate the type of fire protection and whether it is properly maintained.) *
Other Building 2
List the Occupancies: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Other Building Comments: (What is this bldg used for, list what is stored, and how much. Also indicate the type of fire protection and whether it is properly maintained.) *
Other Building 3
List the Occupancies: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Other Building Comments: (What is this bldg used for, list what is stored, and how much. Also indicate the type of fire protection and whether it is properly maintained.) *
Other Building 4
List the Occupancies: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Other Building Comments: (What is this bldg used for, list what is stored, and how much. Also indicate the type of fire protection and whether it is properly maintained.) *
Other Building 5
List the Occupancies: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Other Building Comments: (What is this bldg used for, list what is stored, and how much. Also indicate the type of fire protection and whether it is properly maintained.) *
Other Building 6
List the Occupancies: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Other Building Comments: (What is this bldg used for, list what is stored, and how much. Also indicate the type of fire protection and whether it is properly maintained.) *
Other Building 7
List the Occupancies: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Other Building Comments: (What is this bldg used for, list what is stored, and how much. Also indicate the type of fire protection and whether it is properly maintained.) *
Other Building 8
List the Occupancies: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Other Building Comments: (What is this bldg used for, list what is stored, and how much. Also indicate the type of fire protection and whether it is properly maintained.) *
Other Building 9
List the Occupancies: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Other Building Comments: (What is this bldg used for, list what is stored, and how much. Also indicate the type of fire protection and whether it is properly maintained.) *
Other Building 10
List the Occupancies: *
Building Construction: *
- Frame/Combustible
- Joisted Masonry
- Non-Combustible
- Masonry Non-Combustible
- Modified Fire Resistive
- Fire Resistive
If mixed construction, list the percentage of each type: *
Year Built: *
Number of Stories: *
Building Square Footage: *
Is the building in good condition? *
- Yes
- No
Describe condition concerns: *
Other Building Comments: (What is this bldg used for, list what is stored, and how much. Also indicate the type of fire protection and whether it is properly maintained.) *

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