Homeowners-Rater

Client Name

Address

Effective Date

Coverage A (Dwelling)

Coverage B (Other Structures)

Coverage E (Personal Liability)

Coverage C (Unscheduled Contents)

Coverage D (Loss of Use)

Premise Liability

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)

Permitted Incidental Occupancies (HO-42)

Personal Injury (HO-82)

Is there a Swimming Pool?

Permission to Rent

Additional Residence Rented (HO-70)

Storm Shutters

Select Type

Fire Alarm

Burglar Alarm

Claims Free Discount

Claims Free Years

Coverage Amounts