Homeowners Checklist

HOMEOWNERS CHECKLIST

Each applicant for homeowner’s coverage should be asked all of the following questions. If any additional exposure is identified, the appropriate endorsement or advice should be suggested.

1. If insured is married, have you listed both spouses on the declarations?

Yes ___ No___

2. List all individuals in the household. (Ask specifically about foster children,

wards of the court, foreign exchange students, significant others,

roommates) – not all are covered under the HO …(consider new HO-2000

endorsement for Other members of your Household HO 04 58 …and students away at

School HO 05 27) (Consider rating issues for MAP)

___________________________ __________________________

3. Do you own or rent any other properties? (secondary, vacant land, etc.)?

(If own remember liability needs and property needs) Yes ___ No___

4. List all “Other structures” located on or off your premises.

(HO 04 48 to increase on premises, HO 04 91 or HO 04 92 for off premises other

structures)

___________________________ __________________________

5. Do you rent or hold out for rental any room in your house or in an “Other Structure”? (H0 04 40 if in other structure) Yes ___ No___

6. Is any insured involved in any business interest on or off the premises?

(what do you do that gives you the potential to make money aside from a job where you work for someone else as an employee) Yes ___ No___

7. Please note if any of the above other structures is used for business or

rental. (HO 04 42 for business or rental, HO 04 40 if rented as residence)

8. If business activity what is overall value of contents involved?

On premises ____________ off premises_____________

HO 04 42 for on premises coverage HO 07 01 HOBiz endorsement for on and off

premises coverage)

9. Do you have any children away at college? Yes ___ No___

(HO 05 27 Student away at school for HO-2000 filing)

Names _______________ ________________ _______________

Ages ______ _____ ______

Amount of

Contents with them ______ _____ ______

10. Do you own any of the following types of property? If so, how much?

Jewelry_________ watches_________ furs_________

Silverware, etc. ________ Firearms/equip ________ watercraft ______

Camera equipment _______________ antiques ___________

Musical instruments_______________ Collectibles_________

(consider floater HO 04 61 or HO 04 60) or increasing special limits HO 04 65)

Property in a rented apartment:

on premises __________ off premises _________

(HO 05 46 Increased LL furnishings) (DP policy)

(HO-2000 only)

computer equipment _____________(consider computer endorsement HO 04 14)

Recreational vehicles

Snowmobiles ______________ ATVs ____________

Dirtbikes ______________ Jetskis ___________

Motorized scooters__________ Go-carts __________

Other motorized land conveyances _________________

11. Estimate overall value of contents located on premises ____________

12. Do you live in a homeowners or condo association? Yes ___ No___

(consider additional loss assessment coverage HO 04 35)

13. How old is your home?_________

Are there any building ordinances that would affect repair/reconstruction of your home? (Add HO 04 77) Yes ___ No___

14. Are there rental units on your premises? Do you need to increase Coverage D to respond to loss of rents? Yes ___ No___

15. Would you be interested in the following?

a. Inflation guard or Add’l limits of insurance/guaranteed replacement

cost coverage for the building? Yes ___ No___

(HO 05 02 additional limits all Section I; HO 05 08 Specified limit Coverage A)

b. Replacement cost coverage for contents? Yes ___ No___

(HO 04 90)

c. Replacement cost coverage for metal/brick/plastic fences,

driveways, patios? Yes ___ No___

(HO 04 43 – HO-2000 filing only)

d. Open perils coverage for contents? Yes ___ No___

(HO –15 under HO-91 – sell HO-5 under HO-2000)

e. Sewer back up/sump overflow coverage? Yes ___ No___

(HO 04 95 - $5000 limit)

f. Personal injury coverage? Yes ___ No___

(HO 24 82)

g. Watercraft endorsement or separate boat policy? Yes ___ No___

(HO 24 75 – liability only)

h. Earthquake coverage? Yes ___ No___

(HO 04 54)

i. Extending liability to a rental property? Yes ___ No___

(HO 24 70 – 1 to 4 family structure)

j. Business endorsements or separate policy? Yes ___ No___

(day care endorsements) (HO 04 42 Inc. Occ; HO 07 01 HOBiz; HO 04 97

Daycare)

k. Increased mold coverage?

Section I Yes___ No___

Section II Yes___ No___

(endorsement # varies by policy form HO 04 27 HO-3)

l. Identity fraud coverage? Yes___ No___

HO 04 55 Identity Fraud Expense Endorsement

m. Personal Injury Liability Coverage? Yes___ No___

HO 24 82 Personal Injury Coverage

(consider chat rooms, internet, text messaging, email!)

16. Is there someone living in your home that is not an “insured”?

Yes ___ No___

Consider Other Members of Household End HO 04 58 under HO-2000 only or

HO-4 for individual under HO-2000 or HO-91)

17. Is there a relative who is in “assisted living” (Assisted Living Care

Coverage endorsement) (HO 04 59 – HO-2000 only) Yes ___ No___

18. Is your home owned by a trust? (Residence held in Trust endorsement)

(HO 04 41 under HO-91 this or HO 05 43 under HO-2000 Yes ___ No___

19. Is there someone other than a mortgagee who has a financial interest in

your home? (Additional insured endorsement) Yes ___ No___

if so, (HO 04 41)

Name: __________ address_______________________

20. Do you have any burglar/fire/smoke alarms? Yes ___ No___

(HO 04 16 for credit)

If so: describe _____________________________________________

21. Do you have residence employees? Yes ___ No___

(Does client need W/C policy?)

22. Have you considered flood insurance? Yes ___ No___

23. Have you considered Personal Umbrella Insurance? Yes ___ No___

24. Describe any HO losses submitted to insurance carrier within the last 5

years.

Approximate date loss description amount paid

______________________________________________________________________________________________________________________

25. If a unit owner or a cooperative owner

What are the bylaws, and how much coverage A do you need? _____

Would you like Open perils coverage on:

Building items (H0 17 32) Yes ___ No ____

Contents items (HO 17 31) Yes ___ No ____

Would you like to increase loss assessment coverage? Yes ___ No ____

(HO 04 35)

Do you rent the unit to others? Yes ___ No ____

If so, how much and how long?___________________________

(HO 17 33)

HO-2000 filing HO 17 34 guarantees that Coverage A will respond

To claims in unit if association “single entity” bylaws but master

Policy deductible responds. Would you like this endorsement?

Yes ____No____

Client signature:______________________ date:________________

Agent signature:______________________ date:________________

This checklist addresses normal and usual exclusions and endorsements and policies available for personal residential exposures. It is not an exhaustive list of all endorsements or policy types.

Personal Auto Checklist

Each applicant for personal automobile coverage should be asked all of the following questions. If any additional exposure is identified, the appropriate endorsement or advice should be suggested.

1. List and give the ages of all people who live in the household or who

customarily operate your vehicles if not household members

________________ ___ ________________ ___

2. List all vehicles garaged at the address shown in the coverage selections

page, regardless of ownership.

_______________________ _________________________

_______________________ _________________________ _______________________ _________________________ _______________________ _________________________

3. Do any insureds travel or occasionally rent cars? Yes___ No ___

4. Do any insureds use any vehicle to transport

people or property for a fee? Yes___ No ___

(Is this a public or livery conveyance? Need BAP if so)

5. Do any drivers in the course of his/her work ever drive

a company vehicle? How often, see # 6 and 7 Yes___ No ___

6. Are any insureds furnished a company car? Yes___ No ___

(Use of other auto end M-0051s)

7. Do any insureds regularly/usually use a car that

he/she doesn’t own? (Use of other auto end M-0051s) Yes___ No ___

8. Do any insureds live at a residence other than

the residence shown on the Declarations? Yes___ No ___

(is the vehicle that he/she drives garaged correctly?)

9. Does any insured own any recreational

vehicles? (4 wheelers, dirt bikes, go-carts, etc.) Yes___ No ___

(needs recreational vehicle policy)

Do any qualify for low speed or limited usage plate? Yes___ No___

If so … MAP

10. Does any insured ever travel outside of the USA? Yes___ No ___

11. Do you have any electronic equipment in your car that sends/receives/

reproduces/transmits audio, visual data signals?

a. Is not permanently installed? Yes___ No ___

(need inland marine or possibly HO

coverage if dual power source)

b. That was installed/attached after you

purchased the vehicle? Yes___ No ___

If 11b is so, what is value? _______

If over 1000 – consider endorsement

Consider these …

CB radio? Yes___ No ___ value____

Scanner? Yes___ No ___ value____

TV? Yes___ No ___ value____

VCR? Yes___ No ___ value____

Attached

Car phone Yes___ No ___ value____

Two-way

Mobile radios? Yes___ No ___ value____

Computer Yes__ No___ value ___

Other______ Yes___ No ___ value____

(MPY-0041S Excess Electronic Equipment if attached other than where manufacturer

would put it and valued at over $1000)

13. Do you carry cassette tapes or CD’s in your car? Yes___ No ___

(No coverage under MAP, Probably NO coverage under HO)

14. Do you own any trailers, campers, motorhomes? Yes___ No ___

(Motor home endorsement MPY-002-s – still used by SOME

Companies …but no longer a mandatory endorsement …best if

Not used by company as adds exclusionary language for

for awnings, height extending equipment)

15. Has the pickup or van been customized? Yes___ No ___

(Custom Equipment End. MPY-0037-s)

(once you add the endorsement you LOSE coverage

for awnings, height extending equipment)

16. Does any car have a market value that is

grossly higher than the “normal” book value? Yes___ No ___

(Stated amount endorsement MPY-0027S)

Is it an antique auto with antique auto plate Yes___ No ___

(Antique Auto endorsement M-0047-S)

17. Are any vehicles financed? Yes___ No ___

vehicle name/address financing company

___________________ ___________________________

___________________ ___________________________ ___________________ ___________________________

18. Are any vehicles leased? (Lessor end M0070-S) Yes___ No ___

vehicle name/address leasing company

___________________ ___________________________

19. Are there any operators that you wish to exclude from

using your vehicle? (M-0106) Yes___ No ___

name vehicle to exclude from

_______________ __________________

20. Are there any cars that you would like to add the Original Manufacturers

Parts Endorsement to? MPY-0040S

_______________ __________________

21. Would you like Substitute Transportation coverage for each vehicle?

Vehicle 15/450 30/900 45/1250 100/3000

___________ ____ ___ ____ _____

22. Would you like waiver of deductible coverage on each vehicle that has

collision? (MPY-0016-S) Yes___ No ___

23. Would you like towing on each vehicle? Yes___ No ___

$50. Per disablement Yes___ No ___

$100. Per disablement Yes___ No ___

24. Company specific endorsement options?

Gap coverage Yes___ No___

Replacement cost coverage Yes___ No___

Other Yes___ No___

Client signature:______________________ date:________________

Agent signature:______________________ date:________________

This checklist addresses normal and usual exclusions and endorsements and policies available for personal residential exposures. It is not an exhaustive list of all endorsements or policy types.

List of MA HO forms

HO 00 02 10 00 HOMEOWNERS 2 - BROAD FORM

HO 00 03 10 00 HOMEOWNERS 3 - SPECIAL FORM

HO 00 04 10 00 HOMEOWNERS 4 - CONTENTS BROAD FORM

HO 00 05 10 00 HOMEOWNERS 5 - COMPREHENSIVE FORM

HO 00 06 10 00 HOMEOWNERS 6 - UNIT-OWNERS FORM

HO 01 20 09 01 SPECIAL PROVISIONS - MASSACHUSETTS

HO 03 12 10 00 WINDSTORM OR HAIL PERCENTAGE DEDUCTIBLE

HO 04 10 10 00 ADDITIONAL INTERESTS - RESIDENCE PREMISES

HO 04 12 10 00 INCREASED LIMITS ON BUSINESS PROPERTY

HO 04 14 10 00 SPECIAL COMPUTER COVERAGE

HO 04 16 10 00 PREMISES ALARM OR FIRE PROTECTION SYSTEM

HO 04 18 10 00 DEFERRED PREMIUM PAYMENT

HO 04 26 04 02 LIMITED FUNGI, WET OR DRY ROT, OR BACTERIA COVERAGE –

FOR USE WITH ALL FORMS EXCEPT HO 00 03 AND HO 00 05

HO 04 27 04 02 LIMITED FUNGI, WET OR DRY ROT, OR BACTERIA COVERAGE –

FOR USE WITH FORMS HO 00 03 AND HO 00 05

HO 04 28 04 02 LIMITED FUNGI, WET OR DRY ROT, OR BACTERIA COVERAGE –

FOR USE WITH FORM HO 00 04 WITH HO 05 24 AND FORM HO 00

06 WITH HO 17 31 OR HO 17 32

HO 04 35 10 00 LOSS ASSESSMENT COVERAGE

HO 04 36 10 00 LOSS ASSESSMENT COVERAGE FOR EARTHQUAKE

HO 04 40 10 00 STRUCTURES RENTED TO OTHERS - RESIDENCE PREMISES

HO 04 41 10 00 ADDITIONAL INSURED - RESIDENCE PREMISES

HO 04 42 10 00 PERMITTED INCIDENTAL OCCUPANCIES - RESIDENCE PREMISES

HO 04 43 10 00 REPLACEMENT COST LOSS SETTLEMENT FOR CERTAIN NON-

BUILDING STRUCTURES ON THE RESIDENCE PREMISES

HO 04 46 10 00 INFLATION GUARD

HO 04 48 10 00 OTHER STRUCTURES ON THE RESIDENCE PREMISES –

INCREASED LIMITS

HO 04 49 10 00 BUILDING ADDITIONS AND ALTERATIONS - OTHER RESIDENCE

HO 04 50 10 00 PERSONAL PROPERTY AT OTHER RESIDENCES - INCREASED

LIMIT

HO 04 51 10 00 BUILDING ADDITIONS AND ALTERATIONS - INCREASED LIMIT

HO 04 52 10 00 LIVESTOCK COLLISION COVERAGE

HO 04 53 10 00 CREDIT CARD, ELECTRONIC FUND TRANSFER CARD OR ACCESS

DEVICE, FORGERY AND COUNTERFEIT MONEY COVERAGE –

INCREASED LIMIT

HO 04 54 10 00 EARTHQUAKE

HO 04 55 03 03 IDENTITY THEFT COVERAGE

HO 04 56 10 00 SPECIAL LOSS SETTLEMENT

HO 04 58 10 00 OTHER MEMBERS OF YOUR HOUSEHOLD

HO 04 59 10 00 ASSISTED LIVING CARE COVERAGE

HO 04 60 10 00 SCHEDULED PERSONAL PROPERTY ENDORSEMENT (WITH

AGREED VALUE LOSS SETTLEMENT)

HO 04 61 10 00 SCHEDULED PERSONAL PROPERTY ENDORSEMENT

HO 04 65 10 00 COVERAGE C INCREASED SPECIAL LIMITS OF LIABILITY

HO 04 66 10 00 COVERAGE C INCREASED SPECIAL LIMITS OF LIABILITY - TO BE USED WITH FORM HO 00 05; FORM HO 00 04 WITH ENDORSEMENT HO 05 24 AND FORM HO 00 06 WITH ENDORSEMENT HO 17 31

HO 04 77 10 00 ORDINANCE OR LAW INCREASED AMOUNT OF COVERAGE

HO 04 78 10 00 MULTIPLE COMPANY INSURANCE

HO 04 81 10 00 ACTUAL CASH VALUE LOSS SETTLEMENT

HO 04 90 10 00 PERSONAL PROPERTY REPLACEMENT COST LOSS SETTLEMENT

HO 04 91 10 00 COVERAGE B - OTHER STRUCTURES AWAY FROM THE

RESIDENCE PREM

HO 04 92 10 00 SPECIFIC STRUCTURES AWAY FROM THE RESIDENCE PREMISES