Homeowners-Rater

Client Name

Address

Effective Date

Coverage Amounts

Coverage A (Dwelling)

Coverage B (Other Structures)

Coverage E (Personal Liability)

Coverage C (Unscheduled Contents)

Coverage D (Loss of Use)

Premise Liability

Additional Property Coverages

Scheduled Personal Property - Jewelry

Scheduled Personal Property - Silverware

Scheduled Personal Property - Fine Arts

Scheduled Personal Property - Cameras

Structures Rented to Others (HO-40)

Additional Structures (HO-48)

Special Personal Property (HO-15)

Personal Property Replacement Cost (HO-90)

Additional Liability Coverages

Permitted Incidental Occupancies (HO-42)

Personal Injury (HO-82)

Is there a Swimming Pool?

Permission to Rent

Additional Residence Rented (HO-70)

Policy Credits

Storm Shutters

Select Type

Fire Alarm

Burglar Alarm

Claims Free Discount

Claims Free Years

Coverage Amounts

Additional Property Coverages

Additional Liability Coverages

Policy Credits

Policy Information

Premiums

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Tax: {{oTax:Decimal;C2}}

Total Due: {{oTotal:Decimal;C2}}

Please

Coverage Amounts

Additional Property Coverages

Additional Liability Coverages

Policy Credits

Policy Information

Premiums

Total Premiums: {{oPremiumTotal:Decimal;C2}}

Tax: {{oTax:Decimal;C2}}

Total Due: {{oTotal:Decimal;C2}}