Transcription of Acord Homeowner Application - Abram Interstate Insurance ...
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Acord Homeowner Application - Abram Interstate Insurance ...
Acord CORPORATION 1981-2006. All rights 1 of 4 The Acord name and logo are registered marks of ACORDACORD 80 (2006/10)COMP. DATE:COCFARMSEASONALSECONDARYPRIMARYUSAG E TYPEGROUNDSWIMMING POOLYESNOAPPROVEDFENCEDIVINGBOARDABOVEGR OUNDIN -SLIDENONEOIL STORAGE TANK LOCATIONABOVE GROUND ONMASONRY FLOORABOVE GROUND NOTON MASONRY FLOORABOVEGROUNDBELOWGROUNDINDOORSOUTDOO RSFIRE DISTRICT / CODE NUMBERFIRE / EC RATEFIRE EXTNEIGHBORSVACANTUNOCCDEADBOLTVISIBLE TOTENANTOWNEROCCUPANCYHOUSEKEEPING CONDITION# WKSRENTEDNOYESOCCUPIED DAILY?SPECCLASSRATING# ROOMS# APTS$MARKET VALUE$REPLACEMENT COSTHEAT TYPENONEPRIMARY:SECONDARY:ROOF MATERIALNONECLOSEDOPENFOUNDATIONCIRCUIT BREAKERSNOYESFUSESNOYESYR BUILTSQ FTSUBURBWITHIN PROTFIRE DISTWITHINCITY LIMITSWITHINDWELLING LOCATIONNUMBER OFFIREDIVSUNITS INFIRE DIVTERRCODEDATE HEATING SYSTEMLAST SERVICEDNUM OF AMPS(ELEC SYST)ALUMINUM WIRINGYESNOKNOB & TUBE ORCONDITIONPLUMBING SYSTEMANY KNOWN LEAKSYESNOPLUMBING SYSTEMDATE/PRICEPURCHASERESHSEHLD#ILIES# FAM-RENOVATION TYPEWIRINGPLUMBINGHEATINGROOFINGEXTERIOR PAINTPART COMP YEARLOCALDIRECTCENTRALBURGLARTEMPSMOKESY STEMPROTECTION DEVICE TYPEPROTECTCLASSDISTANCE TOHYDRANTFIRESTATIONFTMICO-O
windstorm loss mitigation * not applicable in nc dwelling other structures personal property loss of use personal liability medical ... convicted of any degree of the crime of fraud, bribery, arson or any other arson-related crime in connection with this or any other property ? (in ri, failure to disclose ... complete and correct to the best of ...
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