Property/Coverage Details |
|
Construction Year |
|
|
Replacement Cost |
% |
|
Dwelling Limit |
|
|
Personal Property Limit |
|
|
Other Structures |
|
|
Loss of Use |
|
|
Liability Limit |
|
|
Medical Limit |
|
|
Deductible Limit |
|
|
Wind/Hail Deductible |
|
|
Number of Units/Families |
|
|
Number of Units in Fire Division |
|
|
Construction |
|
|
Residence Type |
|
|
Occupancy Type |
|
|
Fire Hydrant Distance (feet) |
|
Fire Dept Distance (miles) |
|
|
Is the Dwelling a Modular Home? |
|
|
Is Child Care, Day Care, Dog Kennels, Farming, Riding School or Stables (3 or more horses) or Other Business Conducted on Premises? |
|
|
Is the home occupied
monthly? |
|
|
Is the home closed
for any season? |
|
|
Is the home rented
for any time period? |
|
|
Is there a paid
full-time caretaker? |
|
|
Are there winter
maintenance contracts in place? |
|
Coverage Declined, Canceled or Non-renewed
During the Last 3 Years
for Underwriting reasons or Non-Payment of Premium? |
|
|
Does Applicant or Tenant have any Animals or
Exotic Pets? |
|
|
What
type of pet do you have on premises? |
|
|
List
the types, bite history, and number of other animal(s) in the household. |
|
|
Is the Building Undergoing Renovations or
Reconstruction? |
|
|
Is the House Vacant, Unoccupied or For Sale? |
|
|
Is there a Trampoline on Premises? |
|
|
Is there a swimming pool on premises? |
|
|
Is there an Underground Liquid Fuel Storage
Tank? |
|
|
Any Household Members convicted of Serious
Crimes? |
|
|
Inflation Guard |
|
|
Credit Card, Fund Transfer, Forgery |
|
|
Sewer Backup Coverage |
|
|
Refrigerated Personal Property |
|
|
Is there central heat in the home? |
|
|
Is there supplemental heat in the home? |
|
|
Was the
solid fuel burning stove installed professionally or inspected by a
governmental body? |
|
|
Earthquake Coverage |
|
|
Loss Assessment Coverage |
|
|
Guaranteed Replacement on Dwelling |
|
|
Roof Type |
|
|
Replacement Cost Contents |
|
|
Sinkhole Collapse Coverage |
|
|
Ordinance or Law Coverage |
Ordinance/Law %
|
|
Theft of Jewelry, Watches, and Furs Limit |
Click
to Include |
|
Limit on Money |
Click
to Include |
|
Limit on Securities |
Click
to Include |
|
Theft of Silver/Gold Limit |
Click
to Include |
|
Theft of Firearms Limit |
Click
to Include |
|
Smoke Detector |
|
|
Dead Bolts |
|
|
Fire Extinguisher |
|
|
Fire Alarm |
|
|
Burglary Alarm |
|
|
Sprinkler System |
|
|
Year of Heating Renovation |
|
|
Year of Plumbing Renovation |
|
|
Year of Roofing Renovation |
|
|
Year of Wiring Renovation |
|
| | |
