Certificate of Condition

 

I know of no pre-existing damages or partially repaired damages that have occurred at the insured location prior to the proposed effective date of this policy. I am unaware of any loss, or any loss in progress, and know of no loss that is substantially certain to occur. I understand that this policy is not intended nor do I intend it to provide coverage for any claim or any known damages that have occurred prior to the effective date of the Olympus Insurance Company policy date.

 

Property Address: _________________________________________________________________________________

Applicant’s Signature: ______________________________________________________  Date: ________________

Co-applicant’s Signature: ___________________________________________________ Date: ________________

 

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