Field

Field Required

Data Prefill

Requested Policy Form

✅

❌

Coverage B (% of Coverage A)

❌

❌

Coverage C (% of Coverage A)

❌

❌

Coverage D (% of Coverage A)

❌

❌

Coverage E - Personal Liability

✅

❌

Coverage F - Medical Payments

✅

❌

AOP Deductible

✅

❌

Wind/Hail/Hurricane Deductible

❌

❌

Earthquake Deductible

❌

❌

Replacement Cost Contents

✅

❌

Increased Cost of Construction

❌

❌

Ordinance or Law (%)

❌

❌

Mold/Fungi Coverage

❌

❌

Loss Assessment

❌

❌

Personal Injury

✅

❌

Water Back-up

❌

❌

Roof Loss Settlement

❌

❌

How many stories/floors is the home?

✅

✅

Residence Type

✅

✅

What is the framing of the home?

✅

✅

Type of Roof

✅

✅

Roofing Shape

✅

✅

Type of Plumbing (Check all that apply)

❌

✅

Type of Primary Heating

❌

✅

Number of Units

❌

❌

What is the exterior of the home? (Check all that apply)

✅

✅

Number of Water Heaters

❌

❌

Does your home qualify for discounts? (Check all that apply)

❌

❌

Companion Discounts

❌

❌

Equipment Breakdown

❌

❌

Service Line Coverage

❌

❌

Sinkhole Collapse

❌

❌

Does the home have a historical designation?

✅

❌

Is the home located on more than 5 acres?

✅

✅

Is there a Fuel Tank on the premises?

✅

❌

Does the Named Insureds sit on any Non-Profit Board of Directors?

✅

❌

Is there a Wood Stove in the home?

✅

❌

Do the Named Insureds own a business?

✅

❌

Is the home currently on the market?

✅

❌

Are you renting the home back to the sellers?

✅

❌