What is your first name? *
What is your last name? *
What is your email address? *
What is the address of the home for which you are providing update information? *
Older Structure Updates Form Instructions
Please complete each of the following sections to provide update information about your home's electrical, plumbing, heating and roof systems.
Is the electrical system less than 25 years old? *
Has the electrical system been partially or completely updated? *
What year was the electrical system last updated? *
Is the electrical service 100 Amp or greater, including U/L (Underwriting Laboratories) approved circuit breakers of property amperage? *
Is the wiring U/L (Underwriting Laboratories) approved copper wiring? *
Are wiring and electrical systems in good condition and have not been subject to arcing, shorting out, persistent circuit breaker tripping or caused damage to property within the last 10 years? *
Is there any knob-and-tube or cloth wiring in the home, even if inactive? *
Is the plumbing system less than 25 years old? *
Has the plumbing system been partially or completely updated? *
What year was the plumbing system last updated? *
Is the plumbing in good condition and free of leakage, rupturing or resulting water damage over the last 10 years? *
Has there been any water damage, leaks or plumbing issues in the last 5 years? *
Please describe the mitigation steps taken to prevent future losses? *
Is there any cast iron or lead plumbing still in use? *
What is the age and location of the water heater(s)? *
Is the heating system less than 25 years old? *
Has the heating system been partially or completely updated? *
What year was the heating system last updated? *
Please select the heating type for this home. *
Please select the heating fuel type for this home. *
Is the roofing less than 25 years old? *
Has the roof been partially or completely updated? *
What year was the roof updated? *
What is the primary roof cover of this home? *
What is this home's roof configuration? *
Is any portion of the roof currently in disrepair? *
Please provide a description of the portion(s) of the roof that is in disrepair. *
Have there been any water intrusions within the last five years? *
Please provide details of all water intrusions within the last five years. *
Please provide a description of any other features of your home that have been updated since its original construction.
Please sign your name in the box below. *
Documents and Comments
Please use this field to upload any documents relevant to this structure's updates.
Max. file size: 128 MB, Max. files: 10.
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Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.
Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.