ACORD 42 Instructions

ACORD 42 (2009/07) rev. 07-31-2009 1 of 8

Section Name Field Name Field and/or Section Description
TITLE ACORD 42 (2009/07) Residential Property Replacement Cost Information Supplement The title of the form. ACORD 42, Residential Property Replacement Cost Information Section, is used when your company uses replacement cost calculation methods other than Marshall & Swift or E.H. Boeckh. The company should provide details on how to complete this supplement based on its particular needs.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Loc # Enter number: The producer assigned number of the location.
IDENTIFICATION SECTION Date Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Agency Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
IDENTIFICATION SECTION Carrier Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name.
IDENTIFICATION SECTION NAIC Code Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION Named Insured(s) Enter text: The named insured(s) as it/they will appear on the policy declarations page.
LOCATION OF PROPERTY Street Enter text: The first address line of the physical location.
LOCATION OF PROPERTY City Enter text: The city of the physical location.
LOCATION OF PROPERTY County Enter text: The county of the location.
LOCATION OF PROPERTY State Enter code: The state or province of the physical location.
LOCATION OF PROPERTY Zip Enter code: The postal code of the physical location.
REPLACEMENT COST INFORMATION Evaluation Method Enter code: Indicates the type of evaluation method used for the replacement cost estimation.
REPLACEMENT COST INFORMATION # Stories Enter number: The number of stories for this building not including any basement.
REPLACEMENT COST INFORMATION Ground Floor Area Enter number: The number of square feet of the building or area occupied at this location for which insurance is being requested.

ACORD 42 (2009/07) rev. 07-31-2009 2 of 8

Section Name Field Name Field and/or Section Description
REPLACEMENT COST INFORMATION Total Living Area Enter number: The residence's total square footage of living area (excluding basements).
REPLACEMENT COST INFORMATION Exterior Wall Material Enter code: Indicates the type of material used for exterior walls (e.g., wood, brick, brick veneer, etc.).
REPLACEMENT COST INFORMATION Construction Class/Type Enter code: The primary construction type of the premises. Common construction classifications are: * Frame * Joisted Masonry * Non-Combustible * Masonry Non-Combustible * Modified Fire Resistive * Fire Resistive
REPLACEMENT COST INFORMATION Residence Condition - Excellent Check the box (if applicable): Indicates the residence is in excellent condition.
REPLACEMENT COST INFORMATION Residence Condition - Very Good Check the box (if applicable): Indicates the residence is in very good condition.
REPLACEMENT COST INFORMATION Residence Condition - Good Check the box (if applicable): Indicates the residence is in good condition.
REPLACEMENT COST INFORMATION Residence Condition - Average Check the box (if applicable): Indicates the residence is in average condition.
REPLACEMENT COST INFORMATION Residence Condition - Fair Check the box (if applicable): Indicates the residence is in fair condition.
REPLACEMENT COST INFORMATION Residence Condition - Poor Check the box (if applicable): Indicates the residence is in poor condition.
REPLACEMENT COST INFORMATION Air Conditioning (Checkbox) Heat Ducts Check the box (if applicable): Indicates heating ducts are used for air conditioning.
REPLACEMENT COST INFORMATION Air Conditioning (Checkbox) Separate Ducts Check the box (if applicable): Indicates there are separate ducts for air conditioning.
REPLACEMENT COST INFORMATION Other Air Conditioning Check the box (if applicable): Indicates the type of conveyance for air conditioning is other than those listed.
REPLACEMENT COST INFORMATION Other Air Conditioning Description Enter text: The description of the type of conveyance for air conditioning.
REPLACEMENT COST INFORMATION Air Conditioning $ Enter amount: The value of the air conditioning system.

ACORD 42 (2009/07) rev. 07-31-2009 3 of 8

Section Name Field Name Field and/or Section Description
REPLACEMENT COST INFORMATION Roof Type Enter code: The material used to construct the roof. Examples: * Composition (fiberglass, asphalt, etc.) * Metal * Poured * Slate * Tile * Wood Shake/Shingle
REPLACEMENT COST INFORMATION Roof $ Enter amount: The value of the roof.
REPLACEMENT COST INFORMATION Finished Attic ( Square Feet) Enter number: The total area of the finished attic.
REPLACEMENT COST INFORMATION Finished Attic $ Enter amount: The value of the finished attic.
REPLACEMENT COST INFORMATION (Checkbox) Crawl Check the box (if applicable): Indicates the basement is a crawl space.
REPLACEMENT COST INFORMATION (Checkbox) Slab Check the box (if applicable): Indicates the basement is on a slab.
REPLACEMENT COST INFORMATION (Checkbox) Full Check the box (if applicable): Indicates there is a full basement.
REPLACEMENT COST INFORMATION Sq Feet Basement Enter number: The residence's total square footage of the basement.
REPLACEMENT COST INFORMATION Basement $ Enter amount: The value of the basement and/or recreation room. As used here, this is the value of the basement.
REPLACEMENT COST INFORMATION (Checkbox) Finished Check the box (if applicable): Indicates the basement/recreation room is finished.
REPLACEMENT COST INFORMATION (Checkbox) Walkout Check the box (if applicable): Indicates the basement/recreation room is a walk out.
REPLACEMENT COST INFORMATION Sq Feet Basement Rec Room Enter number: The total area of the basement/recreation room.
REPLACEMENT COST INFORMATION Basement Rec Room $ Enter amount: The value of the basement and/or recreation room. As used here, this is the value of the basement recreation room.
REPLACEMENT COST INFORMATION Breezeway (Checkbox) Open Check the box (if applicable): Indicates the breezeway is open.
REPLACEMENT COST INFORMATION Breezeway (Checkbox) Enclosed Check the box (if applicable): Indicates the breezeway is enclosed.

ACORD 42 (2009/07) rev. 07-31-2009 4 of 8

Section Name Field Name Field and/or Section Description
REPLACEMENT COST INFORMATION Sq Feet Breezeway Enter number: The residence's total square footage of the breezeway.
REPLACEMENT COST INFORMATION Breezeway $ Enter amount: The value of the breezeway.
REPLACEMENT COST INFORMATION Porch Type (Checkbox) Open Check the box (if applicable): Indicates the porch is open.
REPLACEMENT COST INFORMATION Porch Type (Checkbox) Enclosed Check the box (if applicable): Indicates the porch is enclosed.
REPLACEMENT COST INFORMATION Sq Feet Porch Enter number: The area of the porch.
REPLACEMENT COST INFORMATION Porch $ Enter amount: The value of the porch.
REPLACEMENT COST INFORMATION Screen Patio Enclosure Foundation Enter code: Indicates the type of foundation for the screen patio enclosure.
REPLACEMENT COST INFORMATION Screen Patio Enclosure Sq Feet Enter number: The area of the screen patio enclosure.
REPLACEMENT COST INFORMATION Screen Patio $ Enter amount: The value of the screen patio enclosure.
REPLACEMENT COST INFORMATION Number of Chimneys Enter number: The total number of outside and inside chimneys in the residence.
REPLACEMENT COST INFORMATION Number of Hearths Enter number: The total number of hearths in the residence.
REPLACEMENT COST INFORMATION Number of Prefab Fireplaces Enter number: The total number of prefabricated fireplaces in the residence.
REPLACEMENT COST INFORMATION Fireplace $ Enter amount: The total value of the fireplaces.
REPLACEMENT COST INFORMATION Balcony/Deck - Sq Feet Enter number: The total area of the balcony or deck.
REPLACEMENT COST INFORMATION Balcony/Deck $ Enter amount: The value of the balcony or deck.
REPLACEMENT COST INFORMATION Extra Baths - # Half Baths Enter number: The number of half bathrooms.
REPLACEMENT COST INFORMATION Extra Baths - # Full Baths Enter number: The number of full bathrooms.
REPLACEMENT COST INFORMATION Extra Baths $ Enter amount: The total value of all bathrooms.

ACORD 42 (2009/07) rev. 07-31-2009 5 of 8

Section Name Field Name Field and/or Section Description
REPLACEMENT COST INFORMATION Garage Type - Attached Check the box (if applicable): Indicates there is an attached garage.
REPLACEMENT COST INFORMATION Garage Type - Built-In Check the box (if applicable): Indicates there is a built-in garage.
REPLACEMENT COST INFORMATION Garage Type - Carport Check the box (if applicable): Indicates there is a carport.
REPLACEMENT COST INFORMATION Garage Type - Detached Check the box (if applicable): Indicates there is a detached garage.
REPLACEMENT COST INFORMATION Garage Type - Basement Check the box (if applicable): Indicates there is a basement garage.
REPLACEMENT COST INFORMATION Garage Type - Other Check the box (if applicable): Indicates there is a garage other than the types listed.
REPLACEMENT COST INFORMATION Garage Type - Other Description Enter text: The description of the type of garage.
REPLACEMENT COST INFORMATION # Autos Enter number: The number of automobiles the garage can store.
REPLACEMENT COST INFORMATION Garage $ Enter amount: The value of the garage.
REPLACEMENT COST INFORMATION Addition Description Enter text: The description of the addition to the building.
REPLACEMENT COST INFORMATION Addition Type - Sq Feet Enter number: The total area of the addition under construction in square feet.
REPLACEMENT COST INFORMATION Addition $ Enter amount: The value of the addition to the structure.
REPLACEMENT COST INFORMATION Total Built-ins Value Description Enter text: The description of built in appliances, structures, etc. in the structure.
REPLACEMENT COST INFORMATION Built-Ins $ Enter amount: The value of built in appliances, structures, etc. in the structure.
REPLACEMENT COST INFORMATION Land Improvements Enter text: The description of land improvements.
REPLACEMENT COST INFORMATION Land Improvements - $ Enter amount: The value of land improvements.
REPLACEMENT COST INFORMATION Other Enter text: The description of other items that are to be considered for replacement cost coverage.
REPLACEMENT COST INFORMATION Other $ Enter amount: The value of other items to be considered for replacement cost coverage.

ACORD 42 (2009/07) rev. 07-31-2009 6 of 8

Section Name Field Name Field and/or Section Description
ADDITIONAL FEATURES Air Exchanger No Enter number: The number of air exchangers.
ADDITIONAL FEATURES Air Exchanger Value Enter amount: The value of air exchangers.
ADDITIONAL FEATURES Air Humidifier No. Enter number: The number of air humidifiers.
ADDITIONAL FEATURES Air Humidifier Value Enter amount: The value of air humidifiers.
ADDITIONAL FEATURES Carbon Monoxide Detector No. Enter number: The number of carbon monoxide detectors.
ADDITIONAL FEATURES Carbon Monoxide Detector Value Enter amount: The value of carbon monoxide detectors.
ADDITIONAL FEATURES Ceiling Fan No. Enter number: The number of ceiling fans.
ADDITIONAL FEATURES Ceiling Fan Value Enter amount: The value of ceiling fans.
ADDITIONAL FEATURES Central Vacuum System No Enter number: The number of central vacuums.
ADDITIONAL FEATURES Central Vacuum System Value Enter amount: The value of central vacuums.
ADDITIONAL FEATURES Countertop Range No. Enter number: The number of countertop ranges.
ADDITIONAL FEATURES Countertop Range Value Enter amount: The value of countertop ranges.
ADDITIONAL FEATURES Dishwasher No. Enter number: The number of dishwashers.
ADDITIONAL FEATURES Dishwasher Value Enter amount: The value of dishwashers.
ADDITIONAL FEATURES Domestic Solar Hot Water Heater No. Enter number: The number of domestic solar hot water heaters.
ADDITIONAL FEATURES Domestic Solar Hot Water Heater Value Enter amount: The value of domestic solar hot water heaters.
ADDITIONAL FEATURES Dryer (Built-In) No. Enter number: The number of built in dryers.
ADDITIONAL FEATURES Dryer (Built-In) Value Enter amount: The value of built in dryers.
ADDITIONAL FEATURES Electronic Air Filter No. Enter number: The number of electronic air filters.
ADDITIONAL FEATURES Electronic Air Filter Value Enter amount: The value of electronic air filters.
ADDITIONAL FEATURES Elevator No. Enter number: The number of elevators.
ADDITIONAL FEATURES Elevator Value Enter amount: The value of elevators.
ADDITIONAL FEATURES Hot Tub (Not Jetted Tub) No. Enter number: The number of hot tubs.
ADDITIONAL FEATURES Hot Tub (Not Jetted Tub) Value Enter amount: The value of hot tubs.
ADDITIONAL FEATURES Intercom System No. Enter number: The number of intercoms.
ADDITIONAL FEATURES Intercom System Value Enter amount: The value of intercoms.
ADDITIONAL FEATURES Interior Sprinkler System No. Enter number: The number of interior sprinkler systems.
ADDITIONAL FEATURES Interior Sprinkler System Value Enter amount: The value of interior sprinkler systems.
ADDITIONAL FEATURES Oven (Built-In) No. Enter number: The number of built-in ovens.
ADDITIONAL FEATURES Oven (Built-In) Value Enter amount: The value of built-in ovens.
ADDITIONAL FEATURES Roof Exhaust Fan No. Enter number: The number of roof exhaust fans.
ADDITIONAL FEATURES Roof Exhaust Fan Value Enter amount: The value of roof exhaust fans.
ADDITIONAL FEATURES Sauna No. Enter number: The number of saunas.

ACORD 42 (2009/07) rev. 07-31-2009 7 of 8

Section Name Field Name Field and/or Section Description
ADDITIONAL FEATURES Sauna Value Enter amount: The value of saunas.
ADDITIONAL FEATURES Security and Fire Alarms No. Enter number: The number of security and fire alarms.
ADDITIONAL FEATURES Security and Fire Alarms Value Enter amount: The value of security and fire alarms.
ADDITIONAL FEATURES Skylight No. Enter number: The number of skylights.
ADDITIONAL FEATURES Skylight Value Enter amount: The value of skylights.
ADDITIONAL FEATURES Solid Fuel Stoves No. Enter number: The number of solid fuel stoves.
ADDITIONAL FEATURES Solid Fuel Stoves Value Enter amount: The value of solid fuel stoves.
ADDITIONAL FEATURES Trash Compactor No Enter number: The number of trash compactors.
ADDITIONAL FEATURES Trash Compactor Value Enter amount: The value of trash compactors.
ADDITIONAL FEATURES Washer (Built-In) No. Enter number: The number of built-in washers.
ADDITIONAL FEATURES Washer (Built-In) Value Enter amount: The value of built-in washers.
ADDITIONAL FEATURES Water Purification System No. Enter number: The number of water purification systems.
ADDITIONAL FEATURES Water Purification System Value Enter amount: The value of water purification systems.
ADDITIONAL FEATURES Water Softener No. Enter number: The number of water softeners.
ADDITIONAL FEATURES Water Softener Value Enter amount: The value of water softeners.
ADDITIONAL FEATURES Wet Bar No. (Checkbox) Enter number: The number of wet bars.
ADDITIONAL FEATURES Wet Bar Value Enter amount: The value of wet bars.
ADDITIONAL FEATURES Other Features No Enter number: The number of other additional features.
ADDITIONAL FEATURES Other Features Description Enter text: The description of additional features other than those listed.
ADDITIONAL FEATURES Other Features Value Enter amount: The value of other additional features.
ADDITIONAL FEATURES Other Features No Enter number: The number of other additional features.
ADDITIONAL FEATURES Other Features Description Enter text: The description of additional features other than those listed.
ADDITIONAL FEATURES Other Features Value Enter amount: The value of other additional features.
ADDITIONAL FEATURES Other Features No Enter number: The number of other additional features.
ADDITIONAL FEATURES Other Features Description Enter text: The description of additional features other than those listed.
ADDITIONAL FEATURES Other Features Value Enter amount: The value of other additional features.
REMARKS Remarks Enter text: The general remarks for the residential property replacement cost supplement.
ATTACHMENTS Photos Checkbox Check the box (if applicable): Indicates a photograph is attached.
ATTACHMENTS Bill of Sale Checkbox Check the box (if applicable): Indicates a bill of sale is attached.
ATTACHMENTS Other Checkbox Check the box (if applicable): Indicates there is an attachment other than those listed.
ATTACHMENTS Describe Other Enter text: The description of the attachment.
ATTACHMENTS Other Checkbox Check the box (if applicable): Indicates there is an attachment other than those listed.
Section Name Field Name Field and/or Section Description
ATTACHMENTS Describe Other Enter text: The description of the attachment.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Loc # Enter number: The producer assigned number of the location.
PREMISES DIAGRAM Notes Enter text: The general remarks for the residential property replacement cost supplement. As used here, how to get to the premises, nearest cross street, etc.
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).

ACORD 42 (2009/07) rev. 07-31-2009 8 of 8

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