Alarm Information and Fire Protections Form

Alarm Company Details

Alarm Company(Required)

Alarm Company Representative Name(Required)

First Last

Alarm Company Representative Email(Required)

Customer (Account Owner) Details

Customer (Account Owner) Name(Required)

First Last

Customer (Account Owner) E-mail(Required)

Details for Protected Property

Name on Alarm Account(Required)

Premises Address of Protected Property(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Alarm System Details

Is the alarm system U.L. Certified?(Required)

Yes

Communicator Make & Model No.

Primary Communication(Required)

Secondary Communication(Required)

If 'Other' was selected above, please provide details.

Is the alarm system programmed with "Line Security"?(Required)

Yes

U.L. requires alarm systems to be polling at intervals of 360-second or less to achieve "Line Security."

What are the polling / testing intervals?(Required)

Common settings are 200-seconds, 360-seconds, 1-hour, 24-hours, once per week and once per month. If you are unsure, please review the Detailed Alarm Activity Report to check the times between 'TIMER TEST.'

Are all entry doors (pedestrian, garage, bay doors) equipped with contact sensors?(Required)

Yes

Are there strategically positioned motion detectors installed throughout the premises?(Required)

Yes

Additional Alarm Information (if necessary)

Multiple alarm zones, glassbreak sensors, water detection, temperature/humidity controls

Fire Protection Information

Are there smoke detectors installed throughout the premises?(Required)

Yes

Are the smoke detectors hard-wired or wireless?

Hard-wired

Wireless - Local Siren

Wireless "Smart" WiFi Enabled

Are the smoke detectors monitored by a Central Station?

Yes

If the smoke detectors are not monitored by a Central Station, are the smoke detectors "smart" devices (Google Nest Protect, Ring Alarm Smoke, X-Sense Wi-fi Smoke Alarm, etc.)?

Yes

Are the premises fitted with a sprinkler system?(Required)

Yes

Type of sprinkler system?

Wet Pipe

Dry Pipe (Pressurized)

Are there fire extinguishers within the premises?(Required)

Yes

Please list any additional fire protections in place...

Please upload the U.L. Certificate (if applicable) or any other relevant documentation

Drop files here or

Max. file size: 32 MB.

Disclaimer

As Premier Insurance Services, LLC ("Premier") do not possess access to clients' alarm contracts, activity reports and communicator programming settings, Premier specifically rely upon the information provided on this form to be true and accurate. Premier can not be responsible for inaccurate or incomplete information submitted by the reporting party. By submitting this form, you agree that the information you are providing is true and accurate.

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