Property Replacement Cost Evaluation Form

Property Questionnaire
Risman Insurance Account Executive*
Client Name*
Client Email*
example@example.com
Client Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Client Date of Birth

MonthDayYear
Date
Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Purchase Date

MonthDayYear
For a new purchase, enter the estimated or projected closing date (it’s okay if this changes later).
Form of ownership
(EX: Trust, LLC, etc.)
Is the property deeded to a trust or LLC?
What is the name of the LLC?
Who are the owners/members of the LLC?
Does the LLC own any other property?
What is the name of the trust?
Please list the trustees of the trust
In the past 5 years, have you had any property losses or insurance claims at this property or any other property you own?
Loss History Details
Has any insurance company ever non-renewed, canceled, or declined coverage for this property or any other property you own?
Please explain:
Provide any details you remember — such as the insurer’s name, the approximate date, and the reason they gave.
What year was the property built?
Number of living units
Additional Information
What is the home style?
Additional Information
How many stories does the property have?
Excluding finished basement
What is the total square footage of the finished living area of the property?
Square Feet (excluding finished basement)
Does the property have a finished basement?
What percentage is finished?
Slab:blanks %. Crawl Space: blank %.
Stilts: blank %. Other blank f.
What type of materials/finishes are in the kitchen?
Number of bathrooms

Number of full bathrooms:number.
Number of 3/4 bathrooms:number.
Number of 1/2 bathrooms:    number.
Does the property have any of the following security devices? (select all that apply)

Central fire alarmCentral burglar alarmLow temperature monitorHard-wired generatorWater leak detection systemWhole house water shut off valveAutomatic whole house water shut off valveFire sprinklers (all rooms)Fire sprinklers (except in attics, bathrooms & closets)Other
Does the property have a garage?
What type of garage?
Number of garage bays
Does the property have any of the following:
Deck: sq ft .
Breezeway:sq ft
Porch sq ft
Describe any detached structures on your property?
Detached garage, fence, shed, garage, pool house, etc.
Is there a pool on the premises?
Select all that apply

Pool area is fully fencedYard is fully fencedFence has locking gatePool has a slidePool has a diving boardPool has a diving rockLocking ladderOther
Any trampolines on the premises?
Are dogs or other animals in the care/custody of any household member or tenant?
Provide the specific animal type and its breed, if breed is mixed provide all
What type of exterior siding is on the building? (select all that apply)

ClapboardAluminumVinylWood shinglesWoodMasonry/brickWood shakesSolid stoneBrick veneerStone veneerSolid brickKnotty pineLogOther
What type of interior walls are in the property? (select all that apply)

PlasterHorsehairDry WallOther
What type if finish is on the walls? (select all that apply)

PaintWallpaperFaux finishPanelingCeramic tileWoodStoneOther
What type of flooring is in the property? (select all that apply)

HardwoodVinylCarpetCarpet over hardwoodCeramic tileWool/berber carpetMarble tileOther
Is there any business conducted on the premise (including day/childcare or businesses insured elsewhere)?
Do clients or customers come into your home? If yes, how many/how often?
Where in your home do you conduct business? What percentage of your home is used for business purposes?
Is any daycare or childcare provided in the home?
How many children?
Do any occupants/tenants of the property smoke (any form/type including cigarettes, cigars, pipes, etc.)?
Does the property have any of the following? (Select all that apply)

Chair liftElevatorBasketball courtPutting greenTennis courtOther
Do you own any recreational vehicles?
Select all that apply

BoatJet-SkiCamperDirt bikeATV4-wheelerHoverboardOther
Is your home ever held for rental? (Roomers/Boarders/Home sharing)
Please provide additional details:
What type of heat is in the home? (select all that apply)

OilGasElectricPellet StoveWoodstoveFireplaceOther
When was the furnace/boiler last replaced?
When was the oil tank last replaced?
Do you have an underground fuel tank?
Where is your oil tank located?
Does your home have central air conditioning?
What types of electrical are in use in your home: (select all that apply)

Circuit breakersFusesKnob & tubeOther
How many circuit breaker panels are in your home? How many amps for each panel?
EX: One 200 amp panel, one 100 amp panel
Have updates been made to the electrical service?
When was the electrical last updated?
What updates have been made to your electrical service?
Have updates been made to the plumbing?
When was the plumbing last updated?
What updates have been made to your plumbing?
When was your hot water heater last replaced?
EX: May, 2022
What type of roof do you have? When was it last replaced?
EX: Asphalt shingle roof, replaced June, 2013
What type of roof covering is on the property?
Other - Please Describe
Have any updates been made to the roof?
When was the roof last replaced?
Please describe the repairs that have been made to the roof
Other - Please Describe
Does the property have solar panels?
Number of panels
Are the panels owned or leased?
Where are the panels located?
Are you interested in adding any of the following coverages which are not included on a standard homeowners insurance policy?

Lead Liability CoverageFlood insuranceEarthquake insuranceIdentity theftCoverage for back-up of sewers/drainsAdditional ordinance or law coverageAdditional limits for mold, limited fungi, wet/dry rot or bacteria coverageService line coverageEscaped liquid fuel coverage (oil spill coverage)Life insuranceBusiness/Commercial Insurance
A personal umbrella policy provides additional liability coverage over and above your existing home and auto insurance policies (as well as rental properties, boats, vacation homes, etc.) in the event of a covered loss resulting in property damage or bodily injury to others. Would you be interested in adding a personal umbrella policy?
Click here to read more about the importance of a Personal Umbrella Policy.
Personal umbrella policies are available in $1 million increments. You should select a limit that would be sufficient to protect your current and future earnings and assets. Which limits would you like quoted? (select all that apply)

$1 million$2 million$3 million$4 million$5 millionOther
Do you have any valuable items you would like to schedule on your policy? Please provide appraisals/receipts if applicable.
EX: Jewelry, watches, furs, antiques, fine arts, guns, golf clubs, memorabilia, etc.
Click here to read more about the benefits of scheduling your valuable items.
Describe valuable items here:
Please attach any necessary documents here (alarm certificate, copies of current policies, photos, appraisals, etc.)

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Additional information (optional)
Client Signature
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Property Questionnaire