BVSC BVSC. Midwest Technical Inspections Survey Worksheet. Account / Account Code: Insured: Policy #: Building Data - Section 1

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Valerie Leonard
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1 Midwest Technical Inspections Survey Worksheet BVSC BVSC Account / Account Code: Agency: Insured: Policy #: Telephone: Alt. Phone: Building Data - Section 1 Building Name (Entire Valuation) Section Name Co-Insurance % (Entire Valuation) Insured Amount (Entire Valuation) Miscellaneous Cost Adjustments (Entire Valuation) Miscellaneous Adjustment 1 (Entire Valuation) Cost of Adjustment 1 (Entire Valuation) Miscellaneous Adjustment 2 (Entire Valuation) Cost of Adjustment 2 (Entire Valuation) Site Information - Section 1 (Leave blank for system default) Degree of Slope (Choose one value) [_]N/A [_]Level [_]15 degree slope [_]30 degree slope [_]45 degree slope Site Position (Choose one value) [_]N/A [_]Unknown [_]Downhill [_]Uphill Site Accessibility (Choose one value) [_]N/A [_]Excellent [_]Good [_]Fair [_]Poor Soil Condition (Choose one value) [_]N/A [_]Excellent [_]Good [_]Fair [_]Poor Increase % (Overrides previous 4 questions) Depreciation (Leave both blank for No Depreciation) - Section 1 Building Condition (Choose one value) [_]N/A [_]Good [_]Poor [_]Excellent [_]Average [_]Very Poor Effective Age Building Superstructure - Section 1 * # Of Stories * Gross Floor Area Gross Perimeter Construction Quality (Choose one value) [_]N/A [_]Average [_]Superior+ [_]Economy [_]Average+ [_]Premium- [_]Economy+ [_]Superior- [_]Premium [_]Average- [_]Superior [_]Premium+ Year Built * Occupancy Code 1 * Percentage 1 Story Height 1 Occupancy Code 2 Percentage 2 Story Height 2 Occupancy Code 3 Percentage 3 Story Height 3 Occupancy Code 4 Percentage 4 Story Height 4

2 Occupancy Code 5 Percentage 5 Story Height 5 * Construction Type: % Frame * Construction Type: % Joisted Masonry * Construction Type: % Non-Combustible * Construction Type: % Masonry Non-Combustible * Construction Type: % Modified Fire Resistive * Construction Type: % Fire Resistive Building Substructure - Section 1 Unfinished Basement Area Finished Basement Area Basement Occupancy Code Basement Construction Type (Choose one value) [_]None [_]Non-Combustible [_]Modified Fire resistive [_]Frame [_]Masonry Non-Combustible [_]Fire Resistive [_]Joisted Masonry Basement Depth Other: Crawlspace Other: Stilts Wood Other: Stilts Concrete/Steel Other: None - Remove Slab Cost Exterior: Wall Finish - Section 1 Wall Openings (windows & doors) % of total exterior wall surface (Leave blank for system default) Exterior Wall Finish (Choose one value) [_]N/A [_]EIFS on Masonry [_]Siding Metal / Other on Masonry [_]Adobe Block [_]EIFS on Studs [_]Siding Metal / Other on Studs [_]Brick 18" [_]Glass / Metal Curtain Wall [_]Siding Wood on Masonry [_]Brick 24" [_]Glass Block [_]Siding Wood on Studs [_]Brick on Masonry [_]Granite Solid Block 24" [_]Solid Stone 12" [_]Brick on Studs [_]Insulated Sandwich Panel [_]Solid Stone 18" [_]Brick Solid [_]Native Stone on Masonry [_]Solid Stone 24" [_]Concrete Block [_]Native Stone on Studs [_]Stone Panels Curtain Wall [_]Concrete Block Split Face [_]Siding Fiber Cement on Frame [_]Stucco on Masonry [_]Concrete Poured-In-Place [_]Siding Fiber Cement on Masonry [_]Stucco on Studs [_]Concrete Precast Panels [_]Siding Metal / Other on Girts [_]None [_]Concrete Tilt-up Panels Exterior Wall Finish (Choose one value) [_]N/A [_]EIFS on Masonry [_]Siding Metal / Other on Masonry [_]Adobe Block [_]EIFS on Studs [_]Siding Metal / Other on Studs [_]Brick 18" [_]Glass / Metal Curtain Wall [_]Siding Wood on Masonry [_]Brick 24" [_]Glass Block [_]Siding Wood on Studs [_]Brick on Masonry [_]Granite Solid Block 24" [_]Solid Stone 12" [_]Brick on Studs [_]Insulated Sandwich Panel [_]Solid Stone 18" [_]Brick Solid [_]Native Stone on Masonry [_]Solid Stone 24" [_]Concrete Block [_]Native Stone on Studs [_]Stone Panels Curtain Wall [_]Concrete Block Split Face [_]Siding Fiber Cement on Frame [_]Stucco on Masonry [_]Concrete Poured-In-Place [_]Siding Fiber Cement on Masonry [_]Stucco on Studs [_]Concrete Precast Panels [_]Siding Metal / Other on Girts [_]None [_]Concrete Tilt-up Panels

3 Exterior Wall Finish (Choose one value) [_]N/A [_]EIFS on Masonry [_]Siding Metal / Other on Masonry [_]Adobe Block [_]EIFS on Studs [_]Siding Metal / Other on Studs [_]Brick 18" [_]Glass / Metal Curtain Wall [_]Siding Wood on Masonry [_]Brick 24" [_]Glass Block [_]Siding Wood on Studs [_]Brick on Masonry [_]Granite Solid Block 24" [_]Solid Stone 12" [_]Brick on Studs [_]Insulated Sandwich Panel [_]Solid Stone 18" [_]Brick Solid [_]Native Stone on Masonry [_]Solid Stone 24" [_]Concrete Block [_]Native Stone on Studs [_]Stone Panels Curtain Wall [_]Concrete Block Split Face [_]Siding Fiber Cement on Frame [_]Stucco on Masonry [_]Concrete Poured-In-Place [_]Siding Fiber Cement on Masonry [_]Stucco on Studs [_]Concrete Precast Panels [_]Siding Metal / Other on Girts [_]None [_]Concrete Tilt-up Panels Selection 3 Exterior: Roof Materials - Section 1 Exterior Roof Materials (Choose one value) [_]N/A [_]Fiberglass Translucent panels [_]Steel Porcelain Coated [_]Aluminum [_]Metal Sandwich Panels [_]Tile Clay [_]Asphalt shingles [_]Mineral Fiber [_]Tile Concrete [_]Built-up Smooth [_]Single-Ply Membrane [_]Tin (terne) [_]Built-up Tar and Gravel / Rock [_]Slate [_]Wood Shakes / Shingles [_]Copper [_]Steel [_]None [_]Fiberglass shingles Exterior Roof Materials (Choose one value) [_]N/A [_]Fiberglass Translucent panels [_]Steel Porcelain Coated [_]Aluminum [_]Metal Sandwich Panels [_]Tile Clay [_]Asphalt shingles [_]Mineral Fiber [_]Tile Concrete [_]Built-up Smooth [_]Single-Ply Membrane [_]Tin (terne) [_]Built-up Tar and Gravel / Rock [_]Slate [_]Wood Shakes / Shingles [_]Copper [_]Steel [_]None [_]Fiberglass shingles Exterior: Roof Pitch - Section 1 % Flat % Low % Medium % High Interior: Floor Finish - Section 1 Interior Floor Finish (Choose one value)

4 Interior Floor Finish (Choose one value) Interior Floor Finish (Choose one value) Selection 3 Interior Floor Finish (Choose one value) Selection 4 Interior: Wall Partitions - Section 1 (Leave blank for system default) Total Partition Length Interior Wall Partitions (Choose one value) [_]N/A [_]Concrete Poured-In-Place [_]Glass Wall [_]Brick [_]Demountable Partition [_]Studs Wood or Steel [_]Clay Tile [_]Folding Partition [_]Woven Wire [_]Concrete Block [_]Glass Block [_]None Interior Wall Partitions (Choose one value) [_]N/A [_]Concrete Poured-In-Place [_]Glass Wall [_]Brick [_]Demountable Partition [_]Studs Wood or Steel [_]Clay Tile [_]Folding Partition [_]Woven Wire [_]Concrete Block [_]Glass Block [_]None Interior: Wall Finish - Section 1 Interior Wall Finish (Choose one value) [_]N/A [_]Paint [_]Sheet Metal [_]Acoustical Tile (spray) [_]Textured Finish [_]Ceramic Tile (trowel) [_]Wallpaper [_]Cold Storage Insulation [_]Plywood [_]Wood Paneling [_]Drywall [_]Quarry tile [_]None [_]Epoxy

5 Interior Wall Finish (Choose one value) [_]N/A [_]Paint [_]Sheet Metal [_]Acoustical Tile (spray) [_]Textured Finish [_]Ceramic Tile (trowel) [_]Wallpaper [_]Cold Storage Insulation [_]Plywood [_]Wood Paneling [_]Drywall [_]Quarry tile [_]None [_]Epoxy Interior: Ceiling Finish - Section 1 Selection 3 Selection 4 Mechanicals: Heating System - Section 1 Mechanicals Heating System (Choose one value) [_]N/A [_]Gas Oil or Electric Suspended Unit Heaters [_]Steam or Hot Water with Unit Heaters [_]Boiler and Piping Only [_]Heat Pump [_]Thru-wall Units [_]Electric Baseboard or Wall Unit [_]Rooftop Unit [_]Ventilation Only [_]Forced Warm Air [_]Steam or Hot Water with Radiators [_]None Mechanicals Heating System (Choose one value) [_]N/A [_]Gas Oil or Electric Suspended Unit Heaters [_]Steam or Hot Water with Unit Heaters [_]Boiler and Piping Only [_]Heat Pump [_]Thru-wall Units [_]Electric Baseboard or Wall Unit [_]Rooftop Unit [_]Ventilation Only [_]Forced Warm Air [_]Steam or Hot Water with Radiators [_]None

6 Mechanicals: Cooling System - Section 1 Mechanicals Cooling System (Choose one value) [_]N/A [_]Forced Cool Air [_]Unit AC - Air Cooled [_]Chilled Water with Air Handlers [_]Heat Pump [_]Unit AC - Water Cooled [_]Chilled Water with Fan Coil Units [_]Rooftop Unit [_]None [_]Evaporative Coolers [_]Thru-wall Units Mechanicals Cooling System (Choose one value) [_]N/A [_]Forced Cool Air [_]Unit AC - Air Cooled [_]Chilled Water with Air Handlers [_]Heat Pump [_]Unit AC - Water Cooled [_]Chilled Water with Fan Coil Units [_]Rooftop Unit [_]None [_]Evaporative Coolers [_]Thru-wall Units Mechanicals: Plumbing System - Section 1 # of Plumbing Fixtures (Leave blank for system default) Mechanicals: Fire Protection Systems - Section 1 (% of Gross Area) % Sprinkler System % Fire Alarm System % Automatic Fire Detection Mechanicals: Electrical Quality - Section 1 % High % Average % Low % None Mechanicals: Elevators - Section 1 Passenger Elevators # Freight Elevators #

RESIDENTIAL COMPONENT TECHNOLOGY Mobile Manufactured Housing

RESIDENTIAL COMPONENT TECHNOLOGY Mobile Manufactured Housing GENERAL INFORMATION Policy Number: Insured Name: Property Address: Property Zip: Agent: Branch: Current Coverage: _ Account Number: _ PROPERTY