Residential Property Proof Of Insurance

NOTE: All residential structures such as mobile, stick or park model homes must be adequately insured for liability. All sheds and vehicle ports must be, at a minimum, insured for liability coverage if insurance is available. A Shareowner shall provide Management proof of insurance by providing the Insurer’s name, policy # and valid dates. This form must be resubmitted if changes occur. Failure to provide proof of coverage by January 31 shall result in a fine of one-hundred dollars ($100).

False or misrepresentation of insurance coverage may result in action taken against the lot shareowner.

Lot # / Street *

Shareowner’s Name *

First

Last

Shareowner’s Email Address *

Email

Confirm Email

Confirmation will be emailed to this address.

Shareowner’s Phone Number *

Insurance Applies To: *

• Lot Only - No Structures - With or Without Port
• Lot & Storage Structure(s) Only - With or Without Port
• Lot & Residential Structure Only - With or Without Port
• Lot, Residential & Storage Structure(s) - With or Without Port

Select Port Option: *

• The lot does NOT have a port.
• The lot DOES have a port. (Included in Insurance Coverage)

Residential Structure Information

Select Structure *

• Park Model
• Mobile Home
• Permanent On Site Build

Park Model - Year / Model *

Mobile Home - Year / Model *

Year of Permanent On Site Build (If Known)

Storage Structure Details:

Number of Storage Structures/Sheds: *

• One (1)
• Two (2)

Proof Of Insurance Details:

Policy # *

Insurer’s Name: *

Insurance Valid From Date: *

Insurance Valid To Date: *

Insurance Acknowledgement: *

• I acknowledge that the lot listed above has, at a minimum, liability insurance coverage, along with all structures.

Management or Board Review

Submit