| Insurance Coverage Provided by USF&G Specialty Insurance Company | ||||||||
| PRODUCER | |||||||||
| Valid until: 02/09/2001 | Tel: (954) 927-0255 | ||||||||
| Offer number: QJ00019982 | Fax: (954) 923-8499 | ||||||||
| Homeowners Insurance Coverage | |||||||||
| Applicant: | Location of Property to be Insured: | ||||||||
| JOE HIERONIMUS | 5000 18TH AVE W | ||||||||
| 5000 18TH AVE W | BRADENTON, FL. 34209-5125 | ||||||||
| BRADENTON, FL. 34209-5125 | MANATEE COUNTY | ||||||||
| Product Type: HO-3 Homeowner Policy | |||||||||
| Policy Coverage | Limits | Deductibles | Amount | ||||||
| A - Dwelling | $170,000 | Section 1 Deductible | $1,000.00 | ||||||
| B - Other | $17,000 | Windstorm / Hail Deductible * | $8,500.00 | ||||||
| C - Personal Property | $119,000 | ||||||||
| D - Loss of Use | $34,000 | ||||||||
| E - Personal Liability | $300,000 | ||||||||
| F - Med Pay to Others | $2,000 | ||||||||
| Three Pay | Annual | ||||||||
| Due Now (Down Payment) | Base Premium | $1,026.00 | |||||||
| $539.76 | Age of Structure | $103.00 | |||||||
| Due in 90 days** | Optional Endorsements | $.00 | |||||||
| $342.70 | State Tax 5% | $57.70 | |||||||
| Due in 180 days** | FL Surplus Lines Fee | $3.46 | |||||||
| $342.70 | FL Emergency Fund | $2.00 | |||||||
| Policy Fee | $25.00 | ||||||||
| Total | $1,217.16 | ||||||||
| * 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|1956199819971997|1|YInGround|N|2696|0|0|YN|1.88|NNY|N|C|5|0|17 |24|000000000|A|1|2|N100000|63|658|.800|1.9500|1026|103|0|1129|1217.16 |
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