| Insurance Coverage Provided by USF&G Specialty Insurance Company | ||||||||
| PRODUCER | |||||||||
| Valid until: 04/18/2001 | Tel: (305) 387.8920 | ||||||||
| Offer number: QB00081138 | Fax: (305) 387.8945 | ||||||||
| Homeowners Insurance Coverage | |||||||||
| Applicant: | Location of Property to be Insured: | ||||||||
| CAROL GONZALEZ | 918A ORIENTA AVE | ||||||||
| 918A ORIENTA AVE | ALTAMONTE SPRINGS, FL. 32701 | ||||||||
| ALTAMONTE SPRINGS, FL. 32701 | SEMINOLE COUNTY | ||||||||
| Product Type: HO-3 Homeowner Policy | |||||||||
| Policy Coverage | Limits | Deductibles | Amount | ||||||
| A - Dwelling | $115,000 | Section 1 Deductible | $1,000.00 | ||||||
| B - Other | $11,500 | Windstorm / Hail Deductible * | $1,150.00 | ||||||
| C - Personal Property | $80,500 | ||||||||
| D - Loss of Use | $23,000 | ||||||||
| E - Personal Liability | $300,000 | ||||||||
| F - Med Pay to Others | $2,000 | ||||||||
| Three Pay | Annual | ||||||||
| Due Now (Down Payment) | Base Premium | $744.00 | |||||||
| $315.07 | Age of Structure | -$74.00 | |||||||
| Due in 90 days** | Central Station Alarm Discount | -$37.00 | |||||||
| $193.90 | Optional Endorsements | $.00 | |||||||
| Due in 180 days** | State Tax 5% | $32.90 | |||||||
| $193.90 | FL Surplus Lines Fee | $1.97 | |||||||
| FL Emergency Fund | $2.00 | ||||||||
| Policy Fee | $25.00 | ||||||||
| Total | $694.87 | ||||||||
| * 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: |
| FR|P|2|2001200120012001|1|NNone|N|1604|0|0|YN|10|YNY|Y|C|1|0|17|24|00 0000000|B|1|3|N115000|58|483|1.000|1.5400|744|-111|0|633|694.87 |
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