Older Structure Updates Form

What is your first name? **

What is your first name? *

What is your last name? **

What is your last name? *

What is your email address? **

What is your email address? *

What is the address of the home for which you are providing update information? **

What is the address of the home for which you are providing update information? *

Street Address Address Line 2 City State ZIP Code

What year was your home built? **

What year was your home built? *

Older Structure Updates Form Instructions

Please complete each of the following sections to provide update information about your home's electrical, plumbing, heating, exterior and roof systems.

Electrical

Is the electrical system less than 25 years old? **

Is the electrical system less than 25 years old? *

Yes
No
Not sure

Has the electrical system been partially or completely updated? **

Has the electrical system been partially or completely updated? *

Partial
Complete
No updates

What year was the electrical system last 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 electrical service 100 Amp or greater, including U/L (Underwriting Laboratories) approved circuit breakers of property amperage? *

Yes
No
Not sure

Is the wiring U/L (Underwriting Laboratories) approved copper wiring? **

Is the wiring U/L (Underwriting Laboratories) approved copper wiring? *

Yes
No
Not sure

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? **

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? *

Yes
No
Not sure

Is there any knob-and-tube or cloth wiring in the home, even if inactive? **

Is there any knob-and-tube or cloth wiring in the home, even if inactive? *

Yes
No

Plumbing

Is the plumbing system less than 25 years old? **

Is the plumbing system less than 25 years old? *

Yes
No
Not sure

Has the plumbing system been partially or completely updated? **

Has the plumbing system been partially or completely updated? *

Partial
Complete
No updates

What year was the plumbing system last 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? **

Is the plumbing in good condition and free of leakage, rupturing or resulting water damage over the last 10 years? *

Yes
No

Has there been any water damage, leaks or plumbing issues in the last 5 years? **

Has there been any water damage, leaks or plumbing issues in the last 5 years? *

Yes
No

Please describe the mitigation steps taken to prevent future losses? **

Please describe the mitigation steps taken to prevent future losses? *

Is there any cast iron or lead plumbing still in use? **

Is there any cast iron or lead plumbing still in use? *

Yes
No

What is the age and location of the water heater(s)? **

What is the age and location of the water heater(s)? *

Age	Location

Heating

Is the heating system less than 25 years old? **

Is the heating system less than 25 years old? *

Yes
No
Not sure

Has the heating system been partially or completely updated? **

Has the heating system been partially or completely updated? *

Partial
Complete
No updates

What year was the heating system last updated? **

What year was the heating system last updated? *

Please select the heating type for this home. **

Please select the heating type for this home. *

Please select the heating fuel type for this home. **

Please select the heating fuel type for this home. *

Exterior

Primary Exterior*

What is the primary material used for the exterior of this home? *

Has the exterior of the home been partially or completely updated? **

Has the exterior of the home been partially or completely updated? *

Partial
Complete
No updates

What year was the primary exterior material last updated? * (YYYY)*

What year was the primary exterior material last updated? * (YYYY)

Roof

Is the roofing less than 25 years old? **

Is the roofing less than 25 years old? *

Yes
No
Not sure

Has the roof been partially or completely updated? **

Has the roof been partially or completely updated? *

Partial
Complete
No updates

What year was the roof updated? **

What year was the roof updated? *

What is the primary roof cover of this home? **

What is the primary roof cover of this home? *

What is this home's roof configuration? **

What is this home's roof configuration? *

Is any portion of the roof currently in disrepair? **

Is any portion of the roof currently in disrepair? *

Yes
No

Please provide a description of the portion(s) of the roof that is 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? **

Have there been any water intrusions within the last five years? *

Yes
No

Please provide details of all water intrusions within the last five years. **

Please provide details of all water intrusions within the last five years. *

Other Updates

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. **

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.

Drop files here or

Max. file size: 128 MB, Max. files: 10.

Please enter any additional remarks in the space below.

<font size="2" color="gray">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.*

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.

I agree *

Older Structure Updates Form

Older Structure Updates Form Instructions

Electrical

Plumbing

Heating

Exterior

Roof

Other Updates

Documents and Comments

Kurt Thoennessen, CAPI

RiskRevu^TM Newsletter

Contact

Older Structure Updates Form

Older Structure Updates Form Instructions

Electrical

Plumbing

Heating

Exterior

Roof

Other Updates

Documents and Comments

Kurt Thoennessen, CAPI

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RiskRevu^TM Newsletter