Davis, Clark & Latham Ins. Agency Replacement Cost Estimator Form

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Davis, Clark & Latham Ins. Agency
REPLACEMENT COST ESTIMATOR FORM
1 Pleasant Street, Suite 3
Reading, MA 01867
Phone: 781-944-6171 Fax: 781-944-6360
GENERAL INFORMATION
Policy Number:
_________________________
Property Address:
_________________________
Current Coverage:
_________________________
_________________________
Insured Name:
_________________________
_________________________
_________________________
Property Zip:
_________________________
PROPERTY DATA
Usage:
Number of Families:
Primary _____ Secondary _____ Rental _____ Vacant _____
1 _____ 2 _____ 3 _____ 4 _____
IMPORTANT - Total Living Area (in Sq. Ft.) _______________
Main Section
Wing 1
Wing 2
Year Built: _______
Year Built: _______
Year Built: _______
______ Pre-1930
______ Pre-1930
______ Pre-1930
______ Pre-1940
______ Pre-1940
______ Pre-1940
______ Standard
______ Standard
______ Standard
Number of Stories: _______
Number of Stories: _______
Number of Stories: _______
____ Ranch
____ Ranch
____ Ranch
____ Bi-Level
____ Bi-Level
____ Bi-Level
____ 1 Story
____ 1 Story
____ Cape Cod ____ Colonial
____ Cape Cod ____ Colonial
____ Cape Cod ____ Colonial
____ 1 1/2 Story
____ 1 1/2 Story
____ Contemporary
____ Contemporary
____ Contemporary
____ 2 Story
____ 2 Story
____ Raised Ranch
____ Raised Ranch
____ Raised Ranch
____ 2 1/2 Story
____ 2 1/2 Story
____ Split Level
____ Split Level
____ Split Level
____ 3 Story
____ 3 Story
____ Tri-Level
____ Tri-Level
____ Tri-Level
____ Town/Row House - Center Unit
____ Town/Row House - Center Unit
____ Town/Row House - Center Unit
Wing 1
Wing 2
____ Town/Row House - End Unit
____ Town/Row House - End Unit
____ Town/Row House - End Unit
Total Living Area: ___________ sq. ft.
Total Living Area: ___________ sq. ft.
____ Bi-Level/Row - Center Unit
____ Bi-Level/Row - Center Unit
____ Bi-Level/Row - Center Unit
Wing 1 additional
Wing 2 additional
____ Bi-Level/Row - End Unit
____ Bi-Level/Row - End Unit
____ Bi-Level/Row - End Unit
____ Tri-Level/Row - Center Unit
____ Tri-Level/Row - Center Unit
____ Tri-Level/Row - Center Unit
______ % Cathedral Ceiling
______ % Cathedral Ceiling
____ Tri-Level/Row - End Unit
____ Tri-Level/Row - End Unit
____ Tri-Level/Row - End Unit
______ % Slab
______ % Slab
____ Victorian
____ Victorian
____ Victorian
______ % Crawlspace
______ % Crawlspace
____ Ornate Victorian
____ Ornate Victorian
____ Ornate Victorian
______ % Basement
______ % Basement
____ Other: ___________________
____ Other: ___________________
____ Other: ___________________
______ Daylight (Y/N)
______ Daylight (Y/N)
______ % Basement Finished
______ % Basement Finished
Main Section
Main Section
Main Section
______ Custom (Y/N)
______ Custom (Y/N)
Total Living Area: ___________ sq. ft.
Total Living Area: ___________ sq. ft.
Total Living Area: ___________ sq. ft.
______ % Pier Foundation
______ % Pier Foundation
______ % Hillside Foundation
______ % Hillside Foundation
Main Section additional
Access
NOTE: Do not include square footage
NOTE: Do not include square footage
______ % Cathedral Ceiling
____ Flat Area / Easy Access Roads
of finished basement in calculating
of finished basement in calculating
______ % Slab
____ Slightly Congested Roads
Total Living Area.
Total Living Area.
______ % Crawlspace
____ Narrow Roads / Hillside Area
______ % Basement
____ Difficult Access / Steep Terrain
NOTE: If Hillside Foundation is
NOTE: If Hillside Foundation is
______ Daylight (Y/N)
____ Island Access - Short Distance
selected, you must specify both the
selected, you must specify both the
______ % Basement Finished
____ Island Access - Long Distance
slope and access. See the following
slope and access. See the following
______ Custom (Y/N)
____ Elevator Access
page for your choices.
page for your choices.
______ % Pier Foundation
____ Isolated Rural Area
______ % Hillside Foundation
____ Mountain Access
Revised 10/2005
Revised 10/2005

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