Transcription of ACORD 0080 2016-11
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ACORD 0080 2016-11
CIVIL UNION (if applicable)MARITAL STATUS * /CIVIL UNION (if applicable)HOW LONG HAVE YOU KNOWN THE APPLICANTFORM NAMEITEM #BOAT #VEH #FORMS AND ENDORSEMENTS (Attach ACORD 829, Forms and Endorsements Schedule, if more space is required)LOC #FORM NUMBEREDITION DATECOPYRIGHT OWNER CODESUSTAINEDACTUAL LOSSOF USE**Not Applicable in North CarolinaNamed Storm Percentage Deductible in North CarolinaHO FORM #:$$$$$% MAXHURRICANE**HURRICANE*$$$$AMOUNTTYPE%% %%PERCENT$$$$DEDUCTIBLEAMOUNTLIMITINCLUD EDINCLUDEDINCLUDEDOPTIONREPL COST - CONTENTSREPL COST - DWELLINGREPL COST - FULL VALUECOVERAGE* Includes Dwelling, Other Structures, Personal Property, Loss of UseTYPE%%%ANNUALNAMEDTHEFTWIND / HAILBASEPREMIUM%DEDUCTIBLEPERCENTMEDICAL PAYMENTS EA PERPERSONAL LIABILITY EA OCCLOSSPERSONAL PROPERTYCOVERAGELIMITBLANKET *DWELLINGOTHER STRUCTURESPREMIUM$$$$$$$$$$$$$$COVERAGES / LIMITS OF LIABILITY LOC #:DATE AGENT LAST INSPECTED PROPERTYEFFECTIVE DATESTATUS OF TRANSACTIONRENEWNEWPOLICY CHANGEPOLICY CHANGETIMEAMPMC heck if same as Applicant* This field may not be utilized for policyholders applying for residential property insurance in OF BIRTHSOCIAL SECURI
ACORD 80 (2016/11) APPLICABLE IN ARIZONA: Binders are effective for no more than 90 days. APPLICABLE IN COLORADO: The insurer has thirty (30)
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