Property Replacement Cost Evaluation Form

Property Replacement Cost Evaluation Form
Risman Insurance Account Executive*
CSR Email
Client Name*
Client Email*
example@example.com
Client Phone Number
Please enter a valid phone number.
Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Form of ownership
(EX: Trust, LLC, etc.)
What year was your home built?
Is your home a:
Number of living units
Additional Information
What is your home style?
Additional Information
How many stories does your home have?
Excluding finished basement
What is the total square footage of the finished living area of your home?
Square Feet (excluding finished basement)
Does your home 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 your kitchen?
How many bathrooms in your home?
Number of full bathrooms:number.
Number of 3/4 bathrooms:number.
Number of 1/2 bathrooms:    number.
What type of heat is in your home?

OilGasElectricPellet StoveWoodstoveFireplaceOther
When was your furnace/boiler last replaced?
When was your oil tank last replaced?
Do you have an underground fuel tank?
Where is your oil tank located?
Does your home have central air conditioning?
Does your home 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 valveFire sprinklers (all rooms)Fire sprinklers (except in attics, bathrooms & closets)Other
Does your home have a garage?
What type of garage?
Number of garage bays
Does your home 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.
Do you have a pool?
Select all that apply to your pool

Pool area is fully fencedYard is fully fencedFence has locking gatePool has a slidePool has a diving boardPool has a diving rockLocking ladderOther
Do you have a trampoline?
Do you have any pets?
Please list type, breed, bite history and if any aggressive behavior here.
If mixed breed dog, please list all mixes
What type of exterior siding is on your home? (select all that apply)

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

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

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

HardwoodVinylCarpetCarpet over hardwoodCeramic tileWool/berber carpetMarble tileOther
Does your home have solar panels?
Number of panels
Do you own or lease the panels?
Where are the panels located?
Do you conduct any business in your home or in an other structure on your property?
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?
Do you 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:
Do you provide day care in your home?
How many children?
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
What updates have been made to your electrical service and when?
What updates have been made to your plumbing and when?
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
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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