ACORD 42 (2014/08) - RESIDENTIAL PROPERTY REPLACEMENT COST INFORMATION SUPPLEMENT

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Sharlene Norman
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1 ACORD 42 (2014/08) - RESIDENTIAL PROPERTY SUPPLEMENT ACORD 42, Residential Property Replacement Cost Information Supplement, is used when your company uses replacement cost calculation methods other than Marshall & Swift/Boeckh (MSB). The company should provide details on how to complete this supplement based on its particular needs. Section Name Field Name Description Form Page 1 Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g., agency or brokerage). Loc # Enter number: The producer assigned number of the location. Date Enter date: The date on which the form is completed. Agency Enter text: The full name of the producer / agency. Policy Number Effective Date Carrier Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. NAIC Code Enter code: The identification code assigned to the insurer by the NAIC. Named Insured(s) Enter text: The named insured(s) as it / they will appear on the policy declarations page. LOCATION OF PROPERTY Street Enter text: The first address line of the physical location. LOCATION OF PROPERTY City Enter text: The city of the physical location. LOCATION OF PROPERTY County Enter text: The county of the physical location. LOCATION OF PROPERTY State Enter code: The state or province of the physical location. LOCATION OF PROPERTY Zip Enter code: The postal code of the physical location. Evaluation Method Enter code: Indicates the type of evaluation method used for the replacement cost estimation. # Stories Enter number: The number of stories for this building not including any basement. ACORD 42 (2014/08) rev Page 1 of 9

2 Ground Floor Area Total Living Area Exterior Wall Material Construction Class / Type Residence Condition - Excellent Residence Condition - Very Good Residence Condition - Good Residence Condition - Average Residence Condition - Fair Residence Condition - Poor Air Conditioning (Checkbox) Heat Ducts Air Conditioning (Checkbox) Separate Ducts Other Air Conditioning Other Air Conditioning Description Enter number: The number of square feet of the building or area occupied at this location for which insurance is being requested. As used here, this is the area of the ground floor in square feet. Enter number: The residence's total square footage of living area (excluding basements). Enter code: Indicates the type of material used for exterior walls (e.g., wood, brick, brick veneer, etc.). Enter code: The primary construction type of the premises. Common construction classifications are: * Frame * Joisted Masonry * Non-Combustible * Masonry Non-Combustible * Modified Fire Resistive * Fire Resistive Check the box (if applicable): Indicates the residence is in excellent condition. Check the box (if applicable): Indicates the residence is in very good condition. Check the box (if applicable): Indicates the residence is in good condition. Check the box (if applicable): Indicates the residence is in average condition. Check the box (if applicable): Indicates the residence is in fair condition. Check the box (if applicable): Indicates the residence is in poor condition. Check the box (if applicable): Indicates heating ducts are used for air conditioning. Check the box (if applicable): Indicates there are separate ducts for air conditioning. Check the box (if applicable): Indicates the type of conveyance for air conditioning is other than those listed. Enter text: The description of the type of conveyance for air conditioning. ACORD 42 (2014/08) rev Page 2 of 9

3 Air Conditioning $ Roof Type Roof $ Finished Attic ( Square Feet) Finished Attic $ (Checkbox) Crawl (Checkbox) Slab (Checkbox) Full Sq Feet Basement Basement $ (Checkbox) Finished (Checkbox) Walkout Sq Feet Basement Rec Room Basement Rec Room $ Enter amount: The value of the air conditioning system. Enter code: The material used to construct the roof. Examples include: * Composition (fiberglass, asphalt, etc.) * Metal * Poured * Slate * Tile * Wood Shake (Please note this list is not all inclusive) Enter amount: The value of the roof. Enter number: The total area of the finished attic. Enter amount: The value of the finished attic. Check the box (if applicable): Indicates the basement is a crawl space. Check the box (if applicable): Indicates the basement is on a slab. Check the box (if applicable): Indicates there is a full basement. Enter number: The residence's total square footage of the basement. Enter amount: The value of the basement and/or recreation room. As used here, this is the value of the basement. Check the box (if applicable): Indicates the basement/recreation room is finished. Check the box (if applicable): Indicates the basement/recreation room is a walk out. Enter number: The total area of the basement/recreation room. Enter amount: The value of the basement and/or recreation room. As used here, this is the value of the basement recreation room. ACORD 42 (2014/08) rev Page 3 of 9

4 Breezeway (Checkbox) Open Breezeway (Checkbox) Enclosed Sq Feet Breezeway Breezeway $ Porch Type (Checkbox) Open Porch Type (Checkbox) Enclosed Sq Feet Porch Porch $ Screen Patio Enclosure Foundation Screen Patio Enclosure Sq Feet Screen Patio $ Number of Chimneys Number of Hearths Number of Prefab Fireplaces Fireplace $ Balcony / Deck - Sq Feet Balcony / Deck $ Check the box (if applicable): Indicates the breezeway is open. Check the box (if applicable): Indicates the breezeway is enclosed. Enter number: The residence's total square footage of the breezeway. Enter amount: The value of the breezeway. Check the box (if applicable): Indicates the porch is open. Check the box (if applicable): Indicates the porch is enclosed. Enter number: The area of the porch. Enter amount: The value of the porch. Enter code: Indicates the type of foundation for the screen patio enclosure. Enter number: The area of the screen patio enclosure. Enter amount: The value of the screen patio enclosure. Enter number: The total number of outside and inside chimneys in the residence. Enter number: The total number of hearths in the residence. Enter number: The total number of prefabricated fireplaces in the residence. Enter amount: The total value of the fireplaces. Enter number: The total area of the balcony or deck. Enter amount: The value of the balcony or deck. ACORD 42 (2014/08) rev Page 4 of 9

5 Extra Baths - # Half Baths Extra Baths - # Full Baths Extra Baths $ Garage Type - Attached Garage Type - Built-In Garage Type - Carport Garage Type - Detached Garage Type - Basement Garage Type - Other Garage Type - Other Description Enter number: The number of half bathrooms. Enter number: The number of full bathrooms. Enter amount: The total value of all bathrooms. Check the box (if applicable): Indicates there is an attached garage. Check the box (if applicable): Indicates there is a built-in garage. Check the box (if applicable): Indicates there is a carport. Check the box (if applicable): Indicates there is a detached garage. Check the box (if applicable): Indicates there is a basement garage. Check the box (if applicable): Indicates there is a garage other than the types listed. Enter text: The description of the type of garage. # Autos Enter number: The number of automobiles the garage can store. Garage $ Addition Description Addition - Sq Feet Addition $ Total Built-ins Description Built-Ins $ Enter amount: The value of the garage. Enter text: The description of the addition to the building. Enter number: The total area of the addition under construction in square feet. Enter amount: The value of the addition to the structure. Enter text: The description of built in appliances, structures, etc. in the structure. Enter amount: The value of built in appliances, structures, etc. in the structure. ACORD 42 (2014/08) rev Page 5 of 9

6 Land Improvements Land Improvements - $ Other Other $ Enter text: The description of land improvements. Enter amount: The value of land improvements. Enter text: The description of other items that are to be considered for replacement cost coverage. Enter amount: The value of other items to be considered for replacement cost coverage. Air Exchanger No Enter number: The number of air exchangers. Air Exchanger Enter amount: The value of air exchangers. Air Humidifier Enter number: The number of air humidifiers. Air Humidifier Enter amount: The value of air humidifiers. Carbon Monoxide Detector Carbon Monoxide Detector Enter number: The number of carbon monoxide detectors. Enter amount: The value of carbon monoxide detectors. Ceiling Fan Enter number: The number of ceiling fans. Ceiling Fan Enter amount: The value of ceiling fans. Central Vacuum System No Enter number: The number of central vacuums. Central Vacuum System Enter amount: The value of central vacuums. Countertop Range Enter number: The number of countertop ranges. Countertop Range Enter amount: The value of countertop ranges. Dishwasher Enter number: The number of dishwashers. Dishwasher Enter amount: The value of dishwashers. Domestic Solar Hot Water Heater Domestic Solar Hot Water Heater Enter number: The number of domestic solar hot water heaters. Enter amount: The value of domestic solar hot water heaters. Dryer (Built-In) Enter number: The number of built in dryers. ACORD 42 (2014/08) rev Page 6 of 9

7 Dryer (Built-In) Enter amount: The value of built in dryers. Electronic Air Filter Enter number: The number of electronic air filters. Electronic Air Filter Enter amount: The value of electronic air filters. Elevator Enter number: The number of elevators. Elevator Enter amount: The value of elevators. Hot Tub (Not Jetted Tub) Hot Tub (Not Jetted Tub) Enter number: The number of hot tubs. Enter amount: The value of hot tubs. Intercom System Enter number: The number of intercoms. Intercom System Enter amount: The value of intercoms. Interior Sprinkler System Interior Sprinkler System Enter number: The number of interior sprinkler systems. Enter amount: The value of interior sprinkler systems. Oven (Built-In) Enter number: The number of built-in ovens. Oven (Built-In) Enter amount: The value of built-in ovens. Radon Ventilation System Radon Ventilation System Enter number: The number of radon ventilation systems. Enter amount: The value of the radon ventilation system. Roof Exhaust Fan Enter number: The number of roof exhaust fans. Roof Exhaust Fan Enter amount: The value of roof exhaust fans. Sauna Enter number: The number of saunas. Sauna Enter amount: The value of saunas. Security and Fire Alarms Enter number: The number of security and fire alarms. Security and Fire Alarms Enter amount: The value of security and fire alarms. Skylight Enter number: The number of skylights. ACORD 42 (2014/08) rev Page 7 of 9

8 Skylight Enter amount: The value of skylights. Solid Fuel Stoves Enter number: The number of solid fuel stoves. Solid Fuel Stoves Enter amount: The value of solid fuel stoves. Trash Compactor No Enter number: The number of trash compactors. Trash Compactor Enter amount: The value of trash compactors. Washer (Built-In) Enter number: The number of built-in washers. Washer (Built-In) Enter amount: The value of built-in washers. Water Purification System Water Purification System Enter number: The number of water purification systems. Enter amount: The value of water purification systems. Water Softener Enter number: The number of water softeners. Water Softener Enter amount: The value of water softeners. Wet Bar Enter number: The number of wet bars. Wet Bar Enter amount: The value of wet bars. Other Features No Enter number: The number of other additional features. Other Features Description Enter text: The description of additional features other than those listed. Other Features Enter amount: The value of other additional features. Other Features No Enter number: The number of other additional features. Other Features Description Enter text: The description of additional features other than those listed. Other Features Enter amount: The value of other additional features. REMARKS Remarks Enter text: The general remarks for the residential property replacement cost supplement. ATTACHMENTS Photos Checkbox Check the box (if applicable): Indicates a photograph is attached. ATTACHMENTS Bill of Sale Checkbox Check the box (if applicable): Indicates a bill of sale is attached. ATTACHMENTS Other Checkbox Check the box (if applicable): Indicates there is an attachment other than those listed. ATTACHMENTS Describe Other Enter text: The description of the attachment. ATTACHMENTS Other Checkbox Check the box (if applicable): Indicates there is an attachment other than those listed. ACORD 42 (2014/08) rev Page 8 of 9

9 ATTACHMENTS Describe Other Enter text: The description of the attachment. Section Name Field Name Description Form Page 2 Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g., agency or brokerage). Loc # Enter number: The producer assigned number of the location. PREMISES DIAGRAM Notes Enter text: The general remarks for the residential property replacement cost supplement. As used here, use for notes regarding the premises, e.g., how to get to the premises, nearest cross street, etc. ACORD 42 (2014/08) rev Page 9 of 9

Replacement Cost Questionnaire

Replacement Cost Questionnaire 1. Please provide some general information about yourself: A) Name and address of insured location (as it appears on your Homeowners policy): Name: Street Address: City: