INSURED NAME: (1) (2) PROPERTY ADDRESS: CITY ZIP

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Alison Lamb
6 years ago
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Form HV-R401-KEY Key Features Construction Method (Select Site Built Manufactured/Mobile Bldg Type/# Families (Select Single Family Residence Townhouse (inner unit) Duplex/2-family Quadplex/4-family

1 Form HV-R401-KEY Key Features Construction Method (Select Site Built Manufactured/Mobile Bldg Type/# Families (Select Single Family Residence Townhouse (inner unit) Duplex/2-family Quadplex/4-family Total Living Area Sq Ft. Year Built Style (Select one) Ranch/Rambler Colonial Tri-Level/Split-Level Queen Anne Row House A-frame Bungalow Chalet/Alpine Cottage Dome/Geodesic French Georgian Greek/Mediterranean Spanish/Mediterranean Mansion/Luxury Prairie Quad Level Townhouse (Inner unit) Tudor No. of Stories (Select one) ½ Tri-Level/Split Level Building Shape (Select one) 4 Corners 8 Corners 12 Corners Complex H-shape L-shape Square U-shape W-shape one) Modular one) Townhouse Townhouse (outer/end unit) Triplex/3-family Other Cape Cod Bi-level/Raised Ranch Victorian Salt Box Mobile Home Art Deco Cabin Contemporary Custom/Designer Federal Garrison/Frontier Gothic Italian/Mediterranean Log Mission Pueblo Southwestern/Adobe Townhouse (End unit) Other 1 ½ Bi-Level/Raised Ranch Corners 10 Corners 14+ Corners C-shape Irregular Rectangle T-shape V-shape Circular Garage/Carport Type and Size None Carport, Attached Carport, Detached Garage, Attached Garage, Attached, Finished Interior Garage, Basement Garage, Basement, Finished Interior Garage, Built-in Garage, Built-in, Finished Interior Garage, Detached Garage, Detached, Finished Interior Bathrooms (Counts) Economy Standard Custom Full ¾ ½ ¼ Access Type (Select one) Easy access; flat Narrow roads, hilly Island (public ferry service) Elevator required Other (Select up to three) Superior Special Features/Fixtures Slightly congested roads Steep; difficult access Island (private ferry service) Rural and remote area Exterior Wall Type (Must Total 100%) NOTE: Full List version % Adobe Block % Board And Batten % Brick, Solid % Brick, Solid, Custom % Brick on Block % Brick on Block, Custom Brick % Brick Veneer % Brick Veneer, Custom % Lap Siding, Aluminum % Lap Siding, Steel % Lap Siding, Vinyl % Lap Siding, Wood (Clapb d) % Lap Siding, Redwood (Clapb d) % Lap Siding, Wood Composite % Lap Siding, Cement Fiber % Concrete, Poured % Clay Tile % Concrete/Cinder Block, Painted % Concrete, Tile % Ext. Insul. Finish Sys. (EIFS) % Concrete Decor Block, Painted % Log % Greenhouse Glass Wall % Panel Siding, Plywood % Log, Custom, Cedar % Permastone % Panel Siding, Wood Comp. % Shake, Wood % Plank, Barn % Slump Block % Shake, Wood, Victorian Scallop % Shingle, Wood % Shingle, Cement Fiber % Stone, Solid, Custom % Stone, Solid % Stone On Block, Custom % Stone On Block % Stone Veneer, Custom % Stone Veneer % Stucco On Block % Stucco On Frame % Window Wall % T-111 (plywood, simul. wood) % Vert. Tongue & Groove, Cedar

2 Form HV-R401-EXT Exterior Features Roof Cover (Must Total 100%) % Shingle, Asphalt /Fiberglass % Shingle, Asphalt/Arch. High Quality % Shake, Composite % Slate % Tile, Clay, Mission % Tile, Clay, Spanish % Tile, Concrete % Fiberglass Panel % Metal, Copper % Metal, Tin % Shake, Wood, Victorian Scalloped Roof Shape (Must Total 100%) % Arched % Dome % Gable % Hip % Shed % Shingle, Asphalt/Architectural % Shingle, Wood % Shake, Wood % Tile, Cement Fiber % Tile, Clay/Ceramic % Tile, Composite % Tar+Gravel % Single Ply Membrane/Rubber % Metal, Steel % Plexiglass % Roll Roofing % Complex/Custom % Flat % Gambrel % Mansard % Other Attached Structures (Counts) Porch, Enclosed, Small Porch, Screened, Small Porch, Open, Small Deck, Composite, Small Deck, Wood, Small Deck, Redwood, Small Breezeway, Enclosed, Small Breezeway, Screened, Small Breezeway, Open, Small Balcony, Small Greenhouse, Small Patio Cover, Small Solar Room, Small Hot Tub Swimming Pool, Concrete, Medium Swimming Pool, Fiberglass, Medium Screened Enclosure for Pool, Medium Storage Shed, Medium Porch, Enclosed, Medium Porch, Screened, Medium Porch, Open, Medium Deck, Composite, Medium Deck, Wood, Medium Deck, Redwood, Medium Breezeway, Enclosed, Medium Breezeway, Screened, Medium Breezeway, Open, Medium Balcony, Medium Greenhouse, Medium Patio Cover, Medium Solar Room, Medium Indoor Pool Swimming Pool, Concrete, Large Swimming Pool, Fiberglass, Large Screened Enclosure for Pool, Large Storage Shed, Large Porch, Enclosed, Large Porch, Screened, Large Porch, Open, Large Deck, Composite, Large Deck, Wood, Large Deck, Redwood, Large Breezeway, Enclosed, Large Breezeway, Screened, Large Breezeway, Open, Large Balcony, Large Greenhouse, Large Patio Cover, Large Solar Room, Large Swimming Pool, Concrete, Small Swimming Pool, Fiberglass, Small Screened Enclosure for Pool, Small Storage Shed, Small Detached Structures (Counts) Barbecue Cabana Stable, 1-stall Storage Building, Small Swimming Pool, Concrete, Small Swimming Pool, Fiberglass, Small Tennis Court, Asphalt, Unlighted Tennis Court, Clay, Lighted Satellite Dish Other Exterior Features (Counts) Atrium Window Bay Window Stained Glass Window, Small Storm Shutter Sliding Glass Door Skylight, Large Skirting (Hillside) Basketball Court (1/2), Unlighted Fountain Stable, 2-stall Storage Building, Medium Swimming Pool, Concrete, Medium Swimming Pool, Fiberglass, Medium Tennis Court, Asphalt, Lighted Tennis Court, Grass, Unlighted Picture Window Bow Window Stained Glass Window, Large French Doors (Exterior) Skylight, Small Solar Panel Basketball Court (1/2), Lighted Gazebo Stable, 3-stall Storage Building, Large Swimming Pool, Concrete, Large Swimming Pool, Fiberglass, Large Tennis Court, Clay, Unlighted Tennis Court, Grass, Lighted

3 Form HV-R401-INT1 Interior Features Part 1: Major Features (Counts) Kitchen, Economy Kitchen, Custom Fireplace, Masonry, Standard Fireplace, Pre-Fab System Wood/Coal Stove, Free- Standing, Masonry Chimney Whirlpool Tub Vanity Spiral Staircase, Wood Interior Walls (Must total 100%) % Drywall % Plaster % Plaster, Horsehair % Plywood Only % Brick & Block % Adobe % Solid Stone Kitchen, Standard Kitchen, Superior Fireplace, Masonry, Custom Wood/Coal Stove, Free- Standing, Metal Chimney French Doors (Interior) Wet Bar Spiral Staircase, Metal % Drywall, Textured % Plaster, Textured % Studs Only % Block % Stone & Block % Solid Brick Flooring (Must Total 100%) % Hardwood (Wood-Strip) % Carpet, W2W (Acrylic/Nylon) on Hardwood % Carpet, W2W (Plush Acrylic/Nylon) on Hardwood % Carpet, W2W (Wool/Berber) on Hardwood % Flagstone % Terrazzo % Tile-Ceramic % Tile-Cork % Tile-Marble % Tile-Slate % Tile-Vinyl/Rubber -Custom Parquet -Plank -Unknown Type % Carpet, W2W (Acrylic/Nylon) % Carpet, W2W (Plush Acrylic/Nylon) % Carpet, W2W (Wool/Berber) % Carpet, Tile % Laminate % Stone % Tile-Asbestos % Tile-Ceramic, Imported % Tile-Granite % Tile-Mural % Tile-Unknown Type % Vinyl Sheet -Parquet/Block -Plywood % Brick/Pavers Wall Height (Must total 100%) % 8-foot % 9-foot % 10-foot % 11-foot % 12-foot % 13-foot % 14-foot Framing (Must total 100%) 2x4 2x6 % Post+Beam % Steel Wall Finishes (Must Total 100%) % Paint, 1 ct prim, 2 cts finish % Wallpaper, Vinyl % Tile, Ceramic % Paneling, Sheet % Tongue & Groove % Mirrored Walls % Terrazzo % Pegboard % Paint, Sponge Coat % Wallpaper, Foil % Tile, Ceramic, Imported % Paneling, Solid Wood % Millwork % Brick Facing % Carpet % Wainscoting % Faux Paint % Wallpaper, Grass Cloth % Tile, Marble % Knotty Pine % Bookcase Walls % Stone Facing % Corkboard Ceilings (Must Total 100%) % Drywall % Spray Acoustical Texture % Plaster, Patterned % Plaster, Horsehair % Millwork % Plywood Only % Mirrored % Stucco % Faux Paint % Drywall, Textured % Plaster % Plaster, Textured % Acoustical Tiles % Tongue & Groove % Plank % Tin % Carpet % Recessed Lighting % Metal Cathedral % of TLA

4 Form HV-R401-INT2 Interior Features Part 2: Built-ins (Counts) Bar Ice Maker Motorized Roof Window Solar Hot Water Heater Bar Tap Entertainment Center Sauna Washer, Clothes Dehumidifier Remote Controlled Lighting System Video Door Answering System Heating Fuel (Must total 100%) % Coal % Electric % Propane / LPG % Natural Gas % Oil Heating System (Must Total 100%) % Forced Air - Heating Only % Forced Air - Commercial Grade % Gravity Air System % Heat Pump - Water To Air % Radiant Heat - Ceiling % Steam-Boiler, Radiators % Package Terminal Dryer, Clothes Roof Exhaust Fan Video Security System Chandelier Humidifier Soda Fountain Wine Cellar Electronic Air Cleaner Smoke Alarm Water Softener % Electric Baseboard % Forced Air - Heating and Cooling % Forced Hot Water - Boiler/Baseboards % Heat Pump % Radiant Heat % Radiant Heat, Wall % Combination System, Hot Water Heater Elevator Satellite Receiver, DSS Whole-house fan Dumb Waiter Safe, Wall or Floor Stair Lift Ceiling Fan Garage Door Opener Specialty Doors Cooling System (Must Total 100%) % Central A/C-Split System (Shared Ducts) % Chilled Water System % Forced Air - Heating/Cooling % Package Terminal - Roof % Wall Unit A/C Other Systems (Counts) Sprinkler System, Interior Central Burglar Alarm System Central Fire Alarm System Central Vacuum System Intercom System % Central A/C-Commercial Grade % Central A/C % Evaporative Cooler % Forced Air - Heat Pump % Package Terminal - Wall % Ventilator/ Fan Cooling % Window Unit A/C

5 Form HV-R401-SUP Foundation Features: Material (Must total 100%) % Brick % Concrete, Pre-cast Panel % Concrete, Poured % Pipe/Iron % Steel Perimeter Lin. Ft. % Concrete, Block % Concrete, Form Systems % Dirt/Earth/Mud Sill % Structural Insulated Panels % Stone % Other Perimeter Worksheet Attached? Yes No Foundation Type (Must total 100%) % Basement % Crawl Space/Raised % Slab % Pier % Suspended

RESIDENTIAL COMPONENT TECHNOLOGY

RESIDENTIAL COMPONENT TECHNOLOGY GENERAL INFORMATION Policy Number: Insured Name: Property Address: Property Zip: Agent: Branch: Current Coverage: _ Account Number: _ Number of Families: 1 2 3 4 PROPERTY DATA Main Section Wing 1 Wing