Transcription of https://apps.travelers.com/iwcm/AgentHQ/CI/Documents/Applications/ACORD/140.pdf
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https://apps.travelers.com/iwcm/AgentHQ/CI/Documents/Applications/ACORD/140.pdf
DEDTYPEAMOUNTBLKT #TYPEAMOUNTBLKT #LIMIT: $REJECT COVERAGEACCEPT COVERAGEMINE SUBSIDENCE COVERAGE (Required in IL, IN, KY and WV)TYPEDEDBLANKET SUMMARYREFERENCE / LOAN #:EVIDENCE:RANK:CERTIFICATENAME AND ADDRESSACORD 45 attached for additional namesADDITIONAL INTERESTITEM:CLASS:ITEMITEM DESCRIPTIONBUILDING:LOCATION:INTEREST IN ITEM NUMBERMORTGAGEELOSS PAYEEINTERESTPROPERTY HAS BEEN DESIGNATED AN HISTORICAL LANDMARKY / NSOLID FUELBOILERSECONDARY HEATIF BOILER, IS INSURANCE PLACED ELSEWHERE?Y / NSOLID FUELBOILERPRIMARY HEATIF BOILER, IS INSURANCE PLACED ELSEWHERE?GONGLOCALSTATIONCODE NUMBERFIRE DISTRICT# OF OPEN SIDES ON STRUCTURE:VALU-ATIONRIGHT EXPOSURE & DISTANCELEFT EXPOSURE & DISTANCEREAR EXPOSURE & DISTANCEFRONT EXPOSURE & DISTANCEBREAKDOWN OR CONTAMINATIONSELLINGPRICEPOWER OUTAGELIMIT: $REJECT COVERAGEACCEPT COVERAGESINKHOLE COVERAGE (Required in Florida)OPTIONSREFRIG MAINTAGREEMENT(Y / N)$DEDUCTIBLE$LIMITDESCRIPTION OF PROPERT
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