Insurance Service Center DePere - Replacement Cost Estimator

Replacement Cost Estimator Checklist
Client Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What year was your home built?
Years owned?
Name of Responding Fire Dept:
Miles to Fire Department:
Is your home within 1000 feet from a fire hydrant?

YESNO
Township:
County:
Number of Stories
Ground floor area: (in square feet)
Total square feet: (do not include basement)
Construction type:

Site BuiltPrefab/ModularManufacturedLogOther
Roof type
Exterior type (i.e. vinyl)
Size of lot/acreage
Basement:

FullCrawlSlab
How many square feet is your basement?
Is basement finished?

YESNO
If yes, what percentage of your basement is finished?
Is it a walk-out basement?

YESNO
How many amps of electrical?
Other:
Does home have any fuses?

YESNO
Do you have a wood/pellet/coal stove or burner in any structure?

YESNO
(if yes, describe)
Does you have any animals/pets?

YESNO
(if yes, describe)
Any home claims in the last 5 years?

YESNO
(if yes, please explain)
What is the approximate age of:
Roof
Plumbing
Electrical
Furnace
Do you have a garage?

YESNO
How many stalls?
Other
Is it attached to your home?

YESNO
If not attached, what amount do want to insure it for?
Do you have any other buildings (silos, gazebos, sheds)?

YESNO
If yes, list type of buildings & size?
If you have a deck, how many square feet is it?
If you have a porch, how many square feet is it?
If yes, is it open or enclosed?

OpenEnclosed
Number of Bathrooms:
Full Bath (sink, toilet, shower/bath)
Half Bath (sink, toilet)
3/4
Fireplace: (select all that apply)
Gas Fireplace

YESNO
(if yes, how many chimneys?)
Wood Fireplace

YESNO
(if yes, how many chimneys?)
Is your home a single family residence?

YESNO
(if no, how many families?)
Do you have any of the following (check all that apply):

Cigarette smoker(s) in householdMortgage on houseAlarm system (monitored)Geothermal heating systemPlastered walls (versus drywall)TrampolineWood or ceramic floorsSprinkler systemOil or gas tankAluminum wiringSwimming poolJetted bath tubHot tubWater purification systemCustom built homeSkate board rampCentral airWet barHigh valued upgrades
Physical condition:

Excellent: Perfect condition.Good: minor deterioration is visible.Fair: Marked deterioration.Very good: Slight evidence of deterioration.Average: Normal wear and tear is apparent.Poor: Definite deterioration.
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Replacement Cost Estimator Checklist