| Insurance Coverage Provided by USF&G Specialty Insurance Company | ||||||||
| PRODUCER | |||||||||
| Valid until: 04/17/2001 | Tel: (305) 387.8920 | ||||||||
| Offer number: QB00080231 | Fax: (305) 387.8945 | ||||||||
| Homeowners Insurance Coverage | |||||||||
| Applicant: | Location of Property to be Insured: | ||||||||
| ROCHELLE HASSEL | 325 SPRINGFOOT CT. | ||||||||
| 325 SPRINGFOOT CT. | OCOEE, FL. 34761-1866 | ||||||||
| OCOEE, FL. 34761-1866 | ORANGE COUNTY | ||||||||
| Product Type: HO-3 Homeowner Policy | |||||||||
| Policy Coverage | Limits | Deductibles | Amount | ||||||
| A - Dwelling | $65,000 | Section 1 Deductible | $500.00 | ||||||
| B - Other | $6,500 | Windstorm / Hail Deductible * | $650.00 | ||||||
| C - Personal Property | $45,500 | ||||||||
| D - Loss of Use | $13,000 | ||||||||
| E - Personal Liability | $300,000 | ||||||||
| F - Med Pay to Others | $2,000 | ||||||||
| Three Pay | Annual | ||||||||
| Due Now (Down Payment) | Base Premium | $397.00 | |||||||
| $208.17 | Optional Endorsements | $.00 | |||||||
| Due in 90 days** | |||||||||
| $123.10 | State Tax 5% | $21.10 | |||||||
| Due in 180 days** | FL Surplus Lines Fee | $1.27 | |||||||
| $123.10 | FL Emergency Fund | $2.00 | |||||||
| Policy Fee | $25.00 | ||||||||
| Total | $446.37 | ||||||||
| * When
windstorm/hail deductible displays N/A and endorsement HO-04-94 is attached to the policy, the perils of windstorm and hail are excluded. |
Make check payable to Hull & Company, Inc. | ||||||||
| ** $4.00 installment fee included | |||||||||
| Coverage is conditional upon: 1) receipt of
correct premium; and 2) insured's signature on the
Homeowner Application. If check is returned for insufficient funds, no coverage shall take effect. The effective date of coverage is 12:01 AM the day coverage is bound. Future effective dates can be specified. If you desire an effective date in the future, please specify: ______________________ at 12:01 AM. |
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| For Company Use Only: |
| MA|P|4|1979199719921997|1|NNone|N|1000|0|0|NY|15|NNY|N|B|1|0| 17|24|000000000|B|1|2|N65000|58|509|.800|.9750|397|0|0|397|446.37 |
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