Pacific Inspections, Inc.
633
Insured: DE RITO
OPPORTUNITY
FUND
Policy Number:
201CMP100073012
Mailing Address:
Carrier:
Ordered by:
MICHAEL G
CAMPBELL &
ASSOCIARES
Underwriter:
Location Address:
4645 EAST
CHANDLER
BLVD,
PHOENIX,
Risk
Contact
Info
AZ
Contact
Name:
DEBORAH
STORMS
Title: AGENT
Phone Number:
480-339-4000
Vendor Order Number:
Date of Survey: AUGUST 28,
2012
Field Representative: 32016
Inspection Co. Phone #:
PACIFIC INSPECTION INC
323-660-9333
Agency / Broker Contact Info
Agency Name: MICHAEL G
CAMPBELL
Contact Name: DEBORAH
STORMS
Title: AGENT
Phone Number: 480-339-4000
Type of Survey / Coverages:
Special Instructions/Underwriter concerns addressed: CONSTRUCTION TYPE, UTILITIES UPDATES
FOR BUILDINGS 25 YEARS AND OLDER, AUTOMATIC SPRINKLER SYSTEM, OPINION OF
NEIGHBORHOOD, OCCUPANCY RATE, PARKING AREA, BUILDING LOCKED AND SECURED,
SUFFICIENT HEAT TO PRECLUDE FREEZING.
RECOMMENDATIONS / OPINION / PAST LOSSES
Recommendations (yes/no):
NO
# Property:
# General Liability:
1
Opinion:
Comments: SEE NARRATIVE ATTACHED.
Past Losses Discussed (yes/no):
Comments: NONE
OPERATIONS/OCCUPANCY
GENERAL INFORMATION
Insured’s interest in the covered premises:
Years in business:
Basic description of operations on premises:
Years operating at current location:
Seasonal Business (y/n) / In Season :
Resident super or manager on site (y/n):
OCCUPANCY (number of units each type)
Total Number of Units on Premises:
Residential (apartments, dwellings, etc.):
Hotel, Motel, Lodging:
Mercantile/retail:
SPECIFIC TENANT INFORMATION
Any HUD or Section 8? :
Any Students Living on premises? :
Any Assisted Living? :
VACANT PROPERTY SECTION
Percent total area vacant portion represents:
Vacant area(s) secure from unauthorized entry? :
Insured’s plan for the vacant area:
PROPERTY MANAGEMENT
20
MANAGING BUILDING
3
NO
NO
15
O
O
O
Office:
Manufacturing:
Other (describe below):
Vacant:
NO
NO
NO
Percent:
Percent:
Percent:
10%
How long vacant? :
Heat maintained or pipes drained:
YES
TO LEASE
Operations & Occupancy Additional Information:
BUILDING OCCUPIED BY COMMERCIAL BUSINESSES
BUILDING INFORMATION
CONSTRUCTION
ISO Construction Code:
Number Stories:
Year Built:
Number of Buildings:
Avg Distance Betw Bldgs:
ROOF
Roof Construction:
Roof cover material:
Comment
2
1
1994
1
N/A
WOOD
METAL/COMPOSI.
GOOD CONDITION
O
0
1
3
MONTHS
YES
Roof Upgrade (y/ n) / year:
Condition:
WALLS / FLOOR /STAIRS
Walls Construction:
Fire or parapet walls (y/n) /
condition:
Floor Construction:
Stairs are open / closed:
BASEMENT / USAGE
Yes or No / type, usage
RENOVATIONS
In progress (y/n) / extent:
MEASUREMENTS (sq ft)
Area that Insured Occupies:
Entire Building:
Habitational:
Mercantile:
Offices:
Basement:
1994
DRYWALL
YES, GOOD CONDITION
CONCRETE
N/A
N/A
NO
O
14350 SQ FT
O
O
O
Manufacturing:
Vacant:
Parking Lot:
Garage:
Other (specify
below):
O
1800 SQ FT
12375 SQ FT
O
O
O
Building Additional Information:
BUILDING IN GOOD CONDITION
COMMON HAZARDS / BUILDING SERVICES & UTILITIES
ELECTRIC / WIRING
Comment
Type:
CONDUIT
GOOD CONDITION
Over-current Protection Type:
YES
CIRCUIT BREAKERS
Wiring Safely Arranged:
YES
Junction Boxes Covered:
YES
Extension cord overuse:
NO
Evidence of Aluminum
NO
Wiring Observed:
NO
PLUMBING
Material:
COPPER
HEATING
Heating System Type:
ELECTRIC
GOOD CONDITION
Fuel:
N/A
Location:
N/A
Enclosed:
YES
Properly vented:
YES
Last inspection or service date: NOT LEARNED
Heating unit area free of
YES
accumulation?:
Fire Extinguisher and/or
YES
Sand buckets present:
Housekeeping Satisfactory?: YES
Laundry Facility Present?:
Elevator(s) Present?:
NO
Compactor(s) Present?:
BUILDING SERVICES & ROOF UPDATES SUMMARY
Year
Sufficiency/Condition Type of Update / Comments
Electrical
1994
YES, GOOD
Roof
1994
YES, GOOD
Plumbing
1994
YES, GOOD
NO
NO
Heating
(Year installed)
1994
YES, GOOD
GOOD
Common Hazards Additional Information:
NONE OBSERVED AT TIME OF INSPECTION.
SPECIAL HAZARDS (which are present on the premises):
HAZARD
Yes/No HAZARD
Flammables
NO
Pollution
Boilers/Furnaces
NO
Commercial Ovens or Dryers
Welding
NO
Radioactivity
Gases
NO
Auto body spray painting or
similar painting operation
Yes/No
NO
YES
NO
NO
HAZARD
Commercial Cooking
Explosives
High Rack Storage
Other (describe below)
Yes/No
NO
NO
NO
Special Hazards Additional Information:
HUNGRY HOWIES PIZZA 1 OVEN NO COOKING.
PROTECTION / SECURITY (Public & Private)
FIRE
ISO Public Protection Class:
Distance to nearest hydrant:
20 FEET
Distance to fire dept.:
3 MILES
Public Protection type
PAID
(paid, volunteer department):
Bldg Sprinklered
Percent:
100%
Standpipe & Hose present:
NO
Fire Alarm
Central Station:
NO
Adequate number & proper
YES
type Fire Extinguishers (y/n):
Last Inspection or Service:
NOVEMBER 2012
Company:
CINTAS
Smoke Detectors Central Station NO
Smoke detector type:
NONE
Other types of protection:
Heat Sensors
(which are present - Mark with
CO2
“X”)
Monitors
BURGLARY/ SECURITY
Burglar Alarm
Central Station: YES
Video Surveillance (y/n):
NO
Security Guards (y/n):
NO
Premises Secured from
YES
unauthorized access (y/n):
Roof Security present /type:
NO
Comment
Pull Down Alarms
Smoking Controls
NO
NO
PER TENANT
Protection/Security Additional Information:
VACANT SPACE PROPERLY SECURED TO PREVENT UNAUTHORIZED ENTRY.
NEIGHBORING EXPOSURES
Direction
Distance in ft
Front
300
# of Stories / Construction
1
Usage
COMMERCIAL
Rear
Right
Left
400
350
280
1
1
1
COMMERCIAL
COMMERCIAL
COMMERCIAL
Neighborhood & Area Condition/Status:
COMMERCIAL NEIGHBORHOOD, STABLE AREA, GOOD CONDITION.
ADDITIONAL & CATASTROPHE PERILS (evidence of or observed exposure to the following):
PERIL
Yes/No
PERIL
Yes/No
Riot/civil commotion
NO
Lightning
NO
Explosion
NO
Smoke
NO
Vandalism/malicious mischief
NO
Aircraft/Vehicle (damage caused by) NO
Subject to ground sliding or collapse
NO
Burglary & Theft
NO
CATASTROPHE PERILS
Flooding / Water Damage including exposure
NO
Wind or Hail
NO
due to inadequate drainage
Perils Additional Information: NO CATASTROPHE PERILS OBSERVED AT TIME OF INSPECTION.
MISCELLANEOUS ADDITIONAL INFORMATION:
GENERAL LIABILITY SECTION
General Information
Security Guards Present?
Video Surveillance present:
Buzzer /intercom system present:
Attractive nuisances present:
Any liability exposure due to animals such as
guard dogs present?
Hired & Non Owned Auto exposure:
Exterior
Walkways, sidewalks, parking areas in
acceptable condition and slip, trip, fall hazards
controlled?:
Stairs & handrails in acceptable condition:
Acceptable lighting exterior of building:
Designated parking area present:
Acceptable Parking area lighting?:
Window Air conditioners present:
Observed Air conditioners braced?:
Roof drainage noted adequate to discharge
from walking areas:
Balcony railings acceptable?:
Fire escapes in acceptable condition?:
Interior
Interior areas (hallways, lobbies, etc) in
acceptable condition and slip, trip, fall hazards
controlled?:
Stairs, handrails viewed in acceptable
condition:
Yes, No, N/A
NO
NO
NO
NO
NO
NO
YES
N/A
YES
YES
YES
NO
YES
YES
N/A
N/A
YES
N/A
Comment
Elevators present?:
NO
Elevators level properly & maintained?:
N/A
Acceptable lighting interior of building:
YES
Emergency lighting present:
NO
Secondary egress &/or Emergency exits
YES
present:
Exit signs present:
NO
Window guards in areas observed:
N/A
Maximum occupancy signs posted where
NO
appropriate:
Mold presence observed:
NO
Risk Transfer Practices - Certificates of Insurance, Hold Harmless Agreements
Does Insured hire contractors to work on
UTILITIES
HEATING, ELECTRIC, PLUMBING.
premises? / What are the jobs?:
TRADE
Certs of Ins. obtained from contractors:
YES
Certs of Ins. obtained from tenants
YES
that are commercial or mercantile?:
Inspector witnessed where certs are stored:
NO
Facilities / Operations Hazards
Clubhouse or fitness room present:
NO
Other Recreation facilities present:
NO
Laundry facility present:
NO
Food or Liquor served:
NO
Golf course:
NO
High rack storage present:
NO
Other (not otherwise listed, ex. dancing):
NO
Pools / Water Recreation
Swimming pool(s) present:
NO
Proper Drain Covers N/A
Virginia Graeme Baker Act Compliant
Pool area Fenced?:
N/A
Self latching gate on pool fence?:
N/A
Diving board &/or slides present:
N/A
Depth markers present:
N/A
Pool Rules & Hours posted:
N/A
Lifeguards present:
N/A
Pool life safety equipment present:
N/A
Sauna present:
NO
Lakes or Docks present:
NO
General Liability Additional Information:
633 – Cooking Addendum
Pacific Inspections, Inc.
NAME OF ESTABLISHMENT:
RISK TYPE:
COOKING APPLIANCES
(number of units):
FUEL TYPE:
EXTINGUISHING SYSTEM
Automatic Extinguishing System
present?:
Type:
UL 300 Compliant?:
Under Service contract:
Last Serviced:
Service contract frequency:
Comment
Fryers:
Ovens:
Ranges
Woks:
Other:
O
O
1 PIZZA OVEN, NO OTHER
COOKING UNIT.
NO
N/A
N/A
N/A
N/A
N/A
Name of contractor:
N/A
K Class Extinguisher present:
Extinguisher annually serviced:
EXHAUST SYSTEM
Approved exhaust system present for
all cooking equipment:
Hood/Filters meet required
clearances:
Last cleaning:
Under cleaning contract?:
Contract frequency:
Name of contractor:
N/A
YES
OTHER
16” clearance of fryers from surface
Flames or appliances that produce
flash flames:
8”stainless steel baffle plate between
fryer and open flame source:
Fryers equipped with thermostat.:
Fryers equipped with separate high
limit temperature control to shut off
fuel source:
Are metal cans with covers used for
trash & soiled linens:
O
1
O
YES
N/A
N/A
N/A
N/A
N/A
N/A
NO FRYERS, NO OPEN FLAMES.
N/A
N/A
N/A
NO FRYERS
YES
Cooking Additional Information:
HUNGRY HOWIES PIZZA ONLY RESTAURANT ON PREMISES, NO COOKING, 1 PIZZA OVEN
633 – Sprinkler Addendum
Pacific Inspections, Inc.
Sprinkler percent / where:
Main valve chain locked open or
alarms present (tamper, water flow,
other):
Extra heads & wrench available
Nearby:
Valves & Risers Unobstructed:
System Type (Wet, dry,chemical,
CO2, Clean Agent Halon, Other):
Service Frequency:
Last Date of Service:
Service Company:
Bracing present for EQSL:
Type of water supply feed:
Fire Dept. connection to system:
Connection accessible year round:
Covers in place:
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Sprinkler Addendum Additional Information:
NO COMMERCIAL COOKING