Homeowner’s Rewrite Questionnaire Δ Name First Last Date MM slash DD slash YYYY House InformationYear BuiltPlease enter a number less than or equal to 2045.Purchase Date MM slash DD slash YYYY Sq Feet (Excluding Basement)Please enter a number less than or equal to 100000.00.Have you done any renovations that you haven’t already discussed with us? Yes No If yes, please describe:Do you have a Basement? Yes No If yes, is it Full or Partial? Full Partial If partial, % of crawl space and/or slab:Is it Below Grade or Walk Out? Below Grade Walkout % finishedDo you have a Garage? Yes No # of cars it holdsType? Attached Dettached Built-In Do you have a Swimming Pool? Yes No If yes, In-ground or Above Ground? In-Ground Above-Gound Is it Fenced? Yes No Do you have a diving board? Yes No If yes, how high is it?Is there a Sliding Board? Yes No Systems InformationYear roof last replacedShingle TypeRoof ShapeIf flat roof is it: Rubber Tar & Gravel Heat TypeAge of Heater (Years)Please enter a number less than or equal to 300.If Oil: Where is tank located?When was the burner last replaced? (Year)Please enter a number less than or equal to 300.Any alternative/supplemental heat sources such as a wood/coal/pellet stove? Yes No If yes, please describe:Do you have a sump pump? Yes No If yes, does it have a backup? Yes No If yes, type:Protective Devices & InformationDo you have a Burglar Alarm? Yes No If yes, is it: Local Central Station Do you have Dead Bolts? Yes No Do you have Sprinklers? Yes No Do you have a Fire Alarm? Yes No If yes, is it: Local Central Station Do you have Smoke Detectors? Yes No If yes, are they: Hard-wired Battery operated Coverage InformationDo you have any valuable items (ex: jewelry, furs, guns, fine art, or collectibles) that we don’t currently insure? Yes No If yes, please listMiscellaneous InformationDo you have a trampoline? Yes No If yes, is it netted? Yes No Do you have any pets or exotic animals? Yes No If yes, please list them (include breed & bite history)Do you own any other properties or vacant land that we don’t currently insure? Yes No If yes, please list:If yes, who insures those properties?Any properties or vacant land titled in a trust or LLC? Yes No If yes, please list:Do you own any trailers, watercrafts or jet skis, recreational vehicles, snowmobiles, ATVs, or golf carts? Yes No If yes, describe:Is any part of your home available for rent (including vacation rental or home sharing/swapping)? Yes No If yes, describe:Do you have a home based business or a hobby that generates income? Yes No If yes, describe:Do you conduct any type of business on the premises Yes No If yes, describe:Do you have any professional tools or equipment at your home? Yes No If yes, describe:Do you baby-sit or operate a child daycare in your home? Yes No If yes, describe:Any members of your household not related to you? Yes No If yes, describe:If you have children, are any of them full time college students? Yes No If yes, describe:Any member of your household recently married, moved out, separated, or divorced? Yes No If yes, describe:
