DWELLING POLICY PROGRAM EXPOSURE ANALYSIS CHECKLIST

(January 2024)

Dwelling insurance applications used by given carriers include most of the essential information to allow a company to evaluate and underwrite new business. However, the following checklist may be useful in helping a client determine the amount of insurance that is necessary for adequate coverage. It may also identify a need for endorsements to meet either a new or existing insured’s specific exposures.

Related Articles:

Dwelling Policy Program Available Endorsements

Dwelling Policy Program Endorsements Checklist

Brochure: Understanding the ISO Dwelling Policy Program

GENERAL CLIENT INFORMATION

Account: ___________________________________________________________

Account Number: ____________________________________________________

Agency: ____________________________________________________________

Agency Number: _____________________________________________________

Producer: __________________________________________________________

Producer Number: ___________________________________________________

NAMED INSURED(S) __________________________________________________________________

MAILING ADDRESS___________________________________________________________________

Home: Telephone: _____________________

Email: _________________________

Fax: ___________________________

Work: Telephone: ______________________

Email: _________________________

Fax: __________________________

Cell phone numbers:

Named Insured - __________________

Spouse - ________________________

Others: _________________________    

Marital Status: □ Married   □ Single   □ Divorced   □ Separated □ Other ___________________________

Spouse/Significant Other: ___________________________

List below all people who currently reside in the household including:

• Family members
• Persons under 21 in the care of the insured (including foster children)
• Other nonrelated residents (significant others, roomers, boarders, tenants, domestic employees)

NAME	AGE	RELATIONSHIP TO INSURED	OCCUPATION
_________________	_________________	_________________	_________________
_________________	_________________	_________________	_________________
_________________	_________________	_________________	_________________
_________________	_________________	_________________	_________________
_________________	_________________	_________________	_________________

List below all family members who currently do not reside in the household including noncustodial children, college students away at school, or any family living in an assisted living/skilled facility, etc.

NAME	ADDRESS	RELATIONSHIP TO INSURED
_________________	_________________________________	_________________
_________________	_________________________________	_________________
_________________	_________________________________	_________________
_________________	_________________________________	_________________
_________________	_________________________________	_________________

Is any property held in a trust? ___ Yes ___ No

Trust Name: __________________________________

Trustees: ____________________________________

Property: ____________________________________

Is the residence a historical landmark or showcase home? ___ Yes ___ No

If yes, are tours provided? _________ # of people________________

Is the property used for community activities? ___ Yes ___ No

If yes, describe the activities ________________________________________________

_______________________________________________________________________

Does the insured belong to any form of property owners association? ___ Yes ___ No

If yes, attach a copy of the Association agreement and bylaws.

Is the residence located in a flood plain? ___ Yes ___ No

If yes, does the insured carry flood insurance? ___ Yes ___ No

Is the residence located in a known earthquake area? ___ Yes ___ No

If yes, does the insured carry earthquake insurance? ___ Yes ___ No

Does the insured carry firearms or have firearms in the residence? ___ Yes ___ No

If yes, please complete the firearms supplement.

Have there been any water-related losses (including backup of sewers or drains)? ___Yes ___ No

If yes, what items remain in the dwelling that were damaged and repaired instead of being replaced?

___________________________________________________________________________

___________________________________________________________________________

Is there any evidence of water leaking or seeping in the residence? ___Yes ___ No

Are there any odors in the house that could indicate the presence of mold? ___Yes ___ No

Are there underground or above ground storage tanks on premises? ___ Yes ___ No

Is there any storage of flammables, chemicals, or fuels? ___ Yes ___ No

If yes, please describe

_____________________________________________________________________________

_____________________________________________________________________________

Is there lead paint in the residence? ___ Yes ___ No

Is there chemical spraying on premises? ___ Yes ___ No

If yes, describe what is sprayed and whether the insured or contractor does the spraying.

_____________________________________________________________________________

_____________________________________________________________________________

Does the insured own, lease or rent additional residences? ___ Yes ___ No

If yes, complete a separate checklist for each residence.

Does the insured own rental property? ___ Yes ___ No

If yes, develop information on the tenant and the property.

DWELLING – COVERAGE A

Location Address:

___________________________________________

___________________________________________

Lot Size: ______________________________________

Residence square footage: ______________________

Who is owner of record: ______________________________________________

Relationship of named insured to owner of record: ____________________

Mortgageholder:

Name: __________________________________________________

Address: _______________________________________________

Occupancy:  ___ Single family ___ Duplex ___ 3-family ___ 4-family ___ Other

Construction:  ___ Wood frame ___ Masonry veneer ___ Masonry

___Other (describe) ____________________________________

Roofing material: ________________________________

Year built: _________

Number of stories: _______

Type of Heating:

___ Electric ___ Natural Gas ___ LPG ___ Fuel Oil ___ Wood ___Solar

___ Other (describe) __________________________________

Year of last update: Heating_______ Electrical _____ Roof ______ Plumbing _______

Is there a wood burning fireplace? ___Yes ___ No

Is there a wood stove? ___ Yes ___ No

Year of last chimney inspection/cleaning: _____

Is there an alarm system? ___ Yes ___ No

If yes: Type of alarm: ___ Fire ___ Burglar ___ Carbon Monoxide

Is the alarm monitored by police or an alarm company? ___ Yes ___ No

Is there a sprinkler system? ___ Yes ___ No

If yes, describe______________________________________

Description of occupancy:

___ Bedrooms ___ Bathrooms ___ Living Room ___ Dining Room

___ Kitchen ___ Family Room ___ Great Room ___ Library/Study

___ Sauna ___ Exercise Room ___ Recreation Room

___ Attached Garage ___ Sunroom ___ Home Office

___ Other: Describe___________________________________________________

___________________________________________________________________

Has the owner made any improvements or betterments during his or her occupancy? ___ Yes ___ No

If yes, describe the improvement(s) and include the date(s):

_____________________________________________________________________________

_____________________________________________________________________________

ADDITIONAL STRUCTURES – COVERAGE B

Describe all Structures at the same address that are not attached to the residence:

Structure	Const	Year Built	How Used	Rebuild Post Loss?
Garage	_____	_____	_____________________________	_____
Gazebo	_____	_____	_____________________________	_____
Pool	_____	_____	_____________________________	_____
Pool House	_____	_____	_____________________________	_____
Guest House	_____	_____	_____________________________	_____
Greenhouse	_____	_____	_____________________________	_____
Pump House	_____	_____	_____________________________	_____
Play Equipment	_____	_____	_____________________________	_____
Satellite Dish	_____	_____	_____________________________	_____
Fence	_____	_____	_____________________________	_____
Storage	_____	_____	_____________________________	_____
Outdoor Fireplace	_____	_____	_____________________________	_____
Barn	_____	_____	_____________________________	_____
Tennis Courts	_____	_____	_____________________________	_____
Piers, Wharves, Docks	_____	_____	____________________________	_____
Other: (describe)
_____________________	_____	_____	_____________________________	_____
_____________________	_____	_____	_____________________________	_____
_____________________	_____	_____	_____________________________	_____

PERSONAL PROPERTY – COVERAGE C

Location Address:

___________________________________________

___________________________________________

Residence square footage: ____________________________________

Occupancy:  ___ Single Family ___ Duplex ___ 3-Family ___ 4-Family ___ Other

Valuation: ___ Actual Cash Value ___ Replacement Cost

Does the insured have:

Jewelry valued in excess of $1,500? ___ Yes ___ No

Firearms valued in excess of $2,500? ___ Yes ___ No

Silverware valued in excess of $2,500? ___ Yes ___ No

Furs valued in excess of $1,500? ___ Yes ___ No

Property used in business ___ Yes ___ No

Collections ___ Yes ___ No

Antiques ___ Yes ___ No

Fine Arts ___ Yes ___ No

Unusual items that should be scheduled ___ Yes ___ No

More than $250 cash on premises ___ Yes ___ No

If yes to any of the above, additional information will need to be gathered.

Is there personal property off premises? ___ Yes ___ No

If yes, where is it and what is the value?

College student	$______	Storage facility	$______
Another residence	$______	At the gym/club	$______
At work	$______	In a vehicle	$______
Other ________	$______	Other ________	$______

Do insureds regularly travel abroad? ___ Yes ___ No

If yes, what countries? _______________________________________________

LOSS OF USE – COVERAGE D

Location Address:

___________________________________________

___________________________________________

How many individuals live in the primary residence? ___

Does the insured own other dwellings? ___ Yes ___ No

If yes, could the insured live in one of the dwellings after a loss to the primary residence? ___ Yes ___No

Could the insured live with family or friends following a loss? ___ Yes ___ No

If yes, what is the maximum length of time? _________

Are any hotels/motels or lodgings available in the immediate area? ___ Yes ___ No

Are any rental housing/apartments available in the immediate area? ___ Yes ___ No

Would the insured rebuild the primary residence following a loss? ___ Yes ___ No

How long would it take to rebuild the residence after a total loss? ___________

PROPERTY INVENTORY

This listing is intended to provide guidance in three areas:

• Placing all exposures in the proper coverage category
• Insuring to value
• Identifying possible loss of use concerns

Dwelling (Coverage A)

The insured must carry limits equal to 80% of the replacement value of the dwelling if a loss is to be adjusted on a replacement cost basis. Land is not covered, so its value should not be included in any replacement cost calculation. Foundations, excavations, underground wiring, and fixtures are covered but are not considered when determining the 80% insurance to value requirement.

	RCV	ACV	MV
Dwelling	________	________	________
Building additions	________	________	________
Total dwelling value	_______	_______	________
Total Coverage A			$

Additional Structures (Coverage B)

Any automatic coverage provided by the applicable DP form should be considered against the actual coverage need created by the existing, insurable additional structures. 10% (of Coverage A limit) additional coverage is automatically provided under DP 00 02 and DP 00 03. The 10% amount applies under DP 00 01, but any payment reduces the amount available for the dwelling. List all:

Structure	Value	Rebuild (Y/N)
Garage	____________________________________	_______
Gazebo	____________________________________	_______
Pool	____________________________________	_______
Pool House	____________________________________	_______
Guest House	____________________________________	_______
Greenhouse	____________________________________	_______
Pump House	____________________________________	_______
Play Equipment	____________________________________	_______
Satellite Dish	____________________________________	_______
Fence	____________________________________	_______
Storage	____________________________________	_______
Outdoor Fireplace	____________________________________	_______
Barn	____________________________________	_______
Tennis Courts	____________________________________	_______
Piers, Wharves, Docks	____________________________________	_______
Other: (describe)
_____________________	____________________________________	_______
_____________________	____________________________________	_______
_____________________	____________________________________	_______
Total Coverage B		$

Personal Property (Coverage C)

Personal property is for the limit that appears on the declarations. Loss settlement is based on an actual cash valuation. It is important to complete a property inventory to determine the actual limit needed. Items that are specifically scheduled, such as furs, silverware, golf equipment, coin collections, firearms and jewelry should not be part of calculating the general personal property's total value. Remember that carpeting, cabinets, countertops, appliances, and bathroom fixtures are all personal property.

Location	RCV	ACV
Living room	__________	__________
Dining room	__________	__________
Family room	__________	__________
Kitchen	__________	__________
Recreation room	__________	__________
Basement	__________	__________
Master bedroom	__________	__________
Bedroom 2	__________	__________
Bedroom 3	__________	__________
Bedroom 4	__________	__________
Bedroom 5	__________	__________
Library/Study	__________	__________
Bathrooms	__________	__________
Attic	__________	__________
__________ room	__________	__________
__________ room	__________	__________
__________ room	__________	__________
Personal Property located in additional structures	__________	__________
Total on premises Coverage C		$

Loss of Use (Coverage D)

The cost of living elsewhere following a covered cause of loss does not have a specific limit. Instead, the limit is based on a percentage of either the dwelling limit:

Based on Dwelling Limit	Note:
DP 00 01 – 20%	Under DP 00 01, any payment made for loss of use reduces the Coverage A limit for the same loss.
DP 00 02 – 20%
DP 00 03 – 20%
DP 00 08 – 20%	Under DP 00 08, any payment made for loss of use reduces the Coverage A limit for the same loss.

Unfortunately, accommodations are not always easily found because of special life considerations for a particular family. These families may be underinsured unless an inventory of needs and available resources has been developed in advance and additional coverage purchased.

a. Evaluate the extraordinary needs of the household.

What items must be considered that would add to the cost or the ability to find suitable temporary accommodations?

Description	Yes	No
Handicap accessible	_____	_____
Allergy concerns	_____	_____
Pets	_____	_____
Number of family members	_____	_____
Home business	_____	_____
Other	_____	_____

b. Evaluate the availability of accommodations.

Does the insured own property where they can stay following a loss? ___Yes ___No

Can the insured stay with friends or family? ___Yes ___No

Is temporary rental housing available in the surrounding communities? ___Yes ___No

Is temporary lodging (hotels, motels, etc.) available in the surrounding communities?
___Yes ___No

If yes, what is the maximum length of stay? _____ Days

Are there other facilities available to meet temporary housing needs of the insured?
___Yes ___No

If yes, what are the vacancy rates? ____%

If no to the above, what are the insured’s contingency plans if their house becomes uninhabitable?

________________________________________________________________

________________________________________________________________

________________________________________________________________

c. Determine the costs of temporary housing.

What is the "premium" or "bonus" cost the insured would have to pay in order to get space quickly?	$___________
What is the daily cost of a rental unit that meets the minimum requirements of the insured?	$ ____________
What are the per diem costs of other than room expenses?	+$____________
Total per diem costs	$ ____________
Maximum days to reconstruct	X _______ =
Maximum living expenses during reconstruction	+ $ ___________
Bonus costs plus living expenses – Total Coverage D	$ ___________

d. Add the housing and other expenses together and multiply by the maximum number of days needed to rebuild the dwelling to finalize. Add this to the premium or bonus costs to estimate the amount of coverage needed.

e. Compare the costs to the limit provided and adjust the policy if necessary.

PERSONAL LIABILITY

Note: The Liability section’s applicability depends upon the whether the applicant has chosen coverage under the DL-24 01–Personal Liability.

On-Premises Exposures

List all animals kept at the primary residence.

Type	Breed	Weight	Type	Breed	Weight
____________	____________	____________	____________	____________	____________
____________	____________	____________	____________	____________	____________
____________	____________	____________	____________	____________	____________

Are there any outdoor:

Trampolines ___Yes ____No

If yes, provide diameter ____

Playground Equipment ___ Yes ___ No

If yes, provide height ____

Tree House ___ Yes ___ No

If yes, provide height ___

Pool ___ Yes ___ No

Are there activities at the residence that regularly involve non-family members? ___ Yes ___ No

If yes, please describe _________________________________________________________

___________________________________________________________________________

Does anyone in the household host a blog, group forum, or similar Internet activity? ___ Yes ___ No

Are there any bodies of water such as rivers, lakes, ponds, etc., located on the premises? ___ Yes ___ No

If yes, describe the exposure and any protection around it:

_______________________________________________________________

_______________________________________________________________

Are there any other aspects of the insured’s property that would be unusually appealing yet dangerous for children or adolescents? ___ Yes ___ No

If yes, please describe ________________________________________

Off-Premises Exposures

What are the occupations of all insured individuals?

Name	Occupation	Name	Occupation
______________	______________	______________	______________
______________	______________	______________	______________
______________	______________	______________	______________

List all organizations in which any insured individual takes an active role as an unpaid volunteer:

Name	Organization	Job Duty	Name	Organization	Job Duty
___________	___________	___________	___________	___________	___________
___________	___________	___________	___________	___________	___________
___________	___________	___________	___________	___________	___________

Does the organization provide liability and directors and officers coverage for their volunteers? ___ Yes ___ No

Is any insured acting as a trustee or executor of an estate? ___ Yes ___ No

If yes, answer the following questions:

Does the trust or estate provide a bond and other insurance for the benefit of the insured?

___ Yes ___ No

Describe trust or estate property: __________________________________________________

_____________________________________________________________________________

Contracts

Does the insured hire others for construction projects, landscaping, housekeeping, babysitting, etc.?

___ Yes ___ No

If yes, please answer the following questions

Is there a written contract? ___ Yes ___ No

Does the contractor provide a certificate of insurance for work performed? ___ Yes ___ No

Domestic Help

Does the insured employ domestic help? ___ Yes ___ No

If yes, please answer the following questions

List the name of each individual, his or her duties, if he or she live on premises and number of hours he or she works per week.

Name	Job Duties	Live on Premises (Y/N)	Hours per week
_______________________	________________________________	_____	______
_______________________	________________________________	_____	______
_______________________	________________________________	_____	______
_______________________	________________________________	_____	______

Does the insure purchase a workers compensation policy?

If yes, list the carrier name and policy period. _________________________________________

Vacant Land

Does the insured own vacant land? ___ Yes ___ No

If yes, please answer the following question:

List the location of the vacant land and the acreage.

Location description Acreage

____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________