| Insurance Coverage Provided by USF&G Specialty Insurance Company | ||||||||
| PRODUCER | |||||||||
| Quote Valid until: 01/27/2001 | Tel: (954) 927-0255 | ||||||||
| Offer number: QJ00012540 | Fax: (954) 923-8499 | ||||||||
| Homeowners Insurance Coverage | |||||||||
| Applicant: | Location of Property to be Insured: | ||||||||
| CARMEN GONZALEZ | 4101 SW 145TH AVE | ||||||||
| 4101 SW 145TH AVE | MIRAMAR, FL. 33027-3778 | ||||||||
| MIRAMAR, FL. 33027-3778 | BROWARD COUNTY | ||||||||
| Product Type: HO-3 Homeowner Policy | |||||||||
| Policy Coverage | Limits | Deductibles | Amount | ||||||
| A - Dwelling | $255,000 | Section 1 Deductible | $1,000.00 | ||||||
| B - Other | $25,000 | Windstorm / Hail Deductible * | $25,500.00 | ||||||
| C - Personal Property | $178,500 | ||||||||
| D - Loss of Use | $51,000 | ||||||||
| E - Personal Liability | $300,000 | ||||||||
| F - Med Pay to Others | $2,000 | ||||||||
| Three Pay | Annual | ||||||||
| Due Now (Down Payment) | Base Premium | $2,733.00 | |||||||
| $1,080.64 | Age of Structure | -$273.00 | |||||||
| Due in 90 days** | Central Station Alarm Discount | -$137.00 | |||||||
| $700.90 | Optional Endorsements | $.00 | |||||||
| Due in 180 days** | State Tax 5% | $117.40 | |||||||
| $700.90 | FL Surplus Lines Fee | $7.04 | |||||||
| FL Emergency Fund | $2.00 | ||||||||
| Policy Fee | $25.00 | ||||||||
| Total | $2,474.44 | ||||||||
| * 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|5|2000200020002000|1|NNone|N|3884|0|0|NY|10|NNY|Y|C|A|0|17|24| 000000000|A|1|3|N250000|66|1220|.800|2.8000|2733|-410|0|2323|2474.44 |
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