| Insurance Coverage Provided by USF&G Specialty Insurance Company | ||||||||
| PRODUCER | |||||||||
| Quote Valid until: 02/26/2001 | Tel: (954) 927-0255 | ||||||||
| Offer number: QJ00032474 | Fax: (954) 923-8499 | ||||||||
| Homeowners Insurance Coverage | |||||||||
| Applicant: | Location of Property to be Insured: | ||||||||
| CHARLES M. LESS | 5223 RUTLAND CT | ||||||||
| 2009 BALLINA RD | CAPE CORAL, FL. 33904-5650 | ||||||||
| CAZENOVIA, NY 13035 | LEE COUNTY | ||||||||
| Product Type: HO-3 Homeowner Policy | |||||||||
| Policy Coverage | Limits | Deductibles | Amount | ||||||
| A - Dwelling | $190,000 | Section 1 Deductible | $1,000.00 | ||||||
| B - Other | $19,000 | Windstorm / Hail Deductible * | $9,500.00 | ||||||
| C - Personal Property | $133,000 | ||||||||
| D - Loss of Use | $38,000 | ||||||||
| E - Personal Liability | $300,000 | ||||||||
| F - Med Pay to Others | $2,000 | ||||||||
| Three Pay | Annual | ||||||||
| Due Now (Down Payment) | Base Premium | $1,113.00 | |||||||
| $608.17 | Age of Structure | $111.00 | |||||||
| Due in 90 days** | Hurricane Strap Surcharge | $56.00 | |||||||
| $388.00 | Optional Endorsements | $.00 | |||||||
| Due in 180 days** | State Tax 5% | $65.25 | |||||||
| $388.00 | FL Surplus Lines Fee | $3.92 | |||||||
| FL Emergency Fund | $2.00 | ||||||||
| Policy Fee | $25.00 | ||||||||
| Total | $1,376.17 | ||||||||
| * 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|3|1962198719931987|1|NNone|N|2000|0|0|NY|4.96|YYY|N|C|A|0|17| 24|000000000|A|1|3|N75000|57|1109|.800|1.5400|1366|69|0|1435|1539.38 |
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