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Current Carrier

Year Built

Exterior Construction

Square Feet

Current Coverages

Dwelling Replacement Cost

Other Structures

Personal Property

Loss of Use

Personal Liability Limits*
$100,000 $200,000 $300,000 $400,000 $500,000 $1,000,000

Medical Payments*
$1,000 $2,000 $3,000 $4,000 $5,000

Deductible*
1/2% 1% $100 $250 $500 $750 $1,000 1,500 2,000 2,500 3,000 4,000 5,000

Scheduled Items: Jewelry

Scheduled Items: Furs

Scheduled Items: Fine Arts

Scheduled Items: Computer

Sewage and Water Backup

Personal Umbrella

Additional Information