Property Owner/Resident:

Unit Number:

Mailing Address:

Home Phone:

Cell Phone:

Do you have insurance? Yes No

Insurance Company:

Policy Number:

When Did You Obtain Ownership of Your Unit ( Year ):

What changes, if any, have you made to your unit since you obtained ownership?
(i.e.: flooring, painting, cabinetry, baseboards, crown molding, window treatments, etc.)

Do you have tile floors on your balcony? Yes No

If Yes, Please advise what type of flooring is installed and if it was installed by you or a previous owner.

Did you have visible damage(s) in your unit before the cement overspray incident from any cause? Yes No

If yes, please describe the damage(s):

Did your unit sustain ANY visible damage from the cement overspray incident? Yes No

If yes, please describe the damage(s):

Do your windows, balcony railing, balcony flooring, balcony glass and/or sliding doors have cement overspray on them? Yes No

Please Check The Box For The Affected Areas: Windows
Balcony Railing
Balcony Glass
Balcony Floors
Sliding Doors

Did you have visible damage(s) in your unit before the cement overspray incident from any cause? Yes No

Are your windows or sliders difficult to operate? Yes No

Were your windows or sliding doors difficult to operate before the cement overspray incident? Yes No

Do you have visible scratches on your windows and sliding doors? Yes No

Did your windows or sliding doors have cement overspray prior to the incident? Yes No

Have you notified your HO-6 insurance company regarding the cement overspray incident?
If yes, please send us copies of any and all documentation related to those claims. Yes No

Has your unit sustained damage(s) caused by any source other than the cement overspray incident since that event? Yes No

If yes, please describe the damage(s):

Have you repaired the damage(s)? Yes No

Name:

Date:

Signature:

(888) 987-8355

Letter to Residents

ATTENTION & ACTION REQUIRED: PLEASE READ CAREFULLY

THE PLATINUM CONDOMINIUM ASSOCIATION

INDIVIDUAL HOMEOWNER INFORMATION QUESTIONNAIRE