Consumer Friendly Insurance Services
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Home, Renter, Condo, Mobile Home, Landlord insurance.
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Type of Insurance - Select One
Best time to contact you.
Address of Property to be Insured.
State and Zip Code
Date of Birth
Policy Effective Date
Aprox. Insured Value of Property (if known)
Approx. Year Built
Square ft. of your living space.
Occupancy - Select One
Is this your PRIMARY home , Seasonal , Secondary or Tenant occupied.
Number of Units or Families on property.
Type of roof
Flat Tar & Gravel
Flat Foam Composite
Distance to Hydrant (in feet)
Distance to Fire Station (in miles)
Miles from Brush Hazard - Select One
Choose Any that apply
Sprinklers - Select One
Does the home have indoor fire sprinklers.
Theft Alarm - Select One
Fire Alarm - Select One
Limits of Coverages
Coverage A: Replacement Cost of Main Dwelling.
Go to http://www.building-cost.net/ and click the "Start Calculator" button.
and click "Start
Coverage B (10% or A): Value of Other Structures
Value of Separate garage or workshop or other building not attached to the house.
Coverage C (50% of A): Value of Personal Property
Total aproximate value of your personal property you would like to insure.
Coverage D (20% of A): Loss of Use.
Covers your costs of providing shelter for your familty or loss of rents if rental.
Liability Limit - Select One
General liability coverage applies when someone trips on your property and injures themselves.
Medical Payments - Select One
Coverage for immediate medical needs of a guest or occupant who was injured on your property.
Policy Deductible - Select One
The deductible is the portion you pay or take responsibility for before the insurance company's coverage applies. Also called your self insurance.
Exess Dwelling Replacement Cost - (125% recommended)
Excess coverage over and above Coverage A dwelling limit.
Type of Business on Premises
Year of Electrical Update
Year of Plumbing Update
Year of Roof Update
Property Slope in Degrees
Year of Heating Update
Water Heater Secured
If there is a pool, please indicate if it's fenced or not.
Theft Losses (last 3 years)
Non Theft Losses (last 3 years)
Animal liability coverage
is automatically excluded on all policies. However, optional limited animal liability coverage can be purchased for up to $100,000. This coverage does not apply to exotic or unusual pets, vicious animals, certain types of dogs, or farm or ranch animals, such as horses, whether trained or not. (Additional charge.)
Select Limited Animal Liabiltiy
refers to property that has
specifically listed and the value is based on a written appraisal, or saved receipts less depreciation. (Additional charge.)
is any other category of property not
specifically listed per item
Value of Unscheduled Computer Systems
The word unscheduled refers to unlisted or un-itemized computer systems. If you were to schedule a computer system you would list the items by brand name, price and date purchased, and you would need the purchase receipt as evidence of it's value.
Unscheduled Computer Systems
Additional insurance up to $10,000 is available for unscheduled computer systems. No deductible applies to this coverage. (Additonal charge.)
Unscheduled Computer Programs
Additional insurance up to $10,000 is available for unscheduled computer programs. No deductible applies to this coverage. (Additional charge.)
Value of Unscheduled Computer Software
The word unscheduled refers to unlisted or un-itemized computer software. If you were to schedule a computer software you would list the items by brand name, price and date purchased, and you would need the purchase receipt as evidence of it's value.
Additional insurance up to $2,000 is available for data re-creation for computer data erased. No deductible applies to this coverage. (Additional charge.)
Value of Unscheduled Data Re-Creation
The Superior Home Protection Package
broadens and adds
several coverages. Specifically, this endorsement packages the following:
Coverage D (Loss of Use) is extended to cover power interruption caused by an insured peril which makes the residence premises uninhabitable;
Broadened tree debris removal coverage;
Credit Card, Fund Transfer Card, Forgery and Counterfeit Money coverage is increased from $500 to $3,000;
A limit of $5,000 of the policy`s Coverage C (Personal Property) coverage is extended to cover damage to property while away from the residence premises due to flood, earthquake, landslide, or collision or overturn of the conveyance in which your property is carried; and
Lock Replacement Coverage with a limit of $250 is added.
Superior Home Protection Package.
I would like this optional protection.
Identity Theft Protection.
For an additional charge of $25, Identity Theft Coverage can
be added to the policy. This coverage offers $25,000 for expenses incurred by an insured as a direct result of an identity theft discovered during the policy period. Additionally, the coverage offers access to resolution services from a consumer fraud specialist who assists in the process of restoring the identity of the insured from first call to crisis resolution. No deductible applies to this coverage.
For an additional charge of $40, Identity Theft with ID Alert Coverage can be added to the policy. This coverage offers the same benefits of Identity Theft Coverage, plus ID Alert coverage. ID Alert provides a monthly proactive National Database screening and notification by phone or
email of possible fraud of an insured that has provided Name, Address and Social Security Number.
Select Identity Theft Coverage.
ID Theft Only.
ID Theft with ID Alert.
Earthquake (Additional charge)
I would like this optional coverage .
Scheduled Personal Property.
Coverage for Scheduled Personal Property can be provided against all risks of direct physical loss, with certain exceptions. Complete descriptions of scheduled property must be given. Types of property that can be scheduled are: Jewelry, Furs, Cameras, Musical Instruments, Silverware, Golf Equipment, Fine Arts, Postage Stamps, Rare and Current Coins, and Firearms. (Additional charge.)
Scheduled Personal Property.
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Marketing program by Consumer Friendly Insurance Services
Independent Property & Casualty Insurance Broker. Licensed in California, New York and Texas
CA Lic: F046058, TX Lic: BR-1160689, NY Lic: 1634590, copyright 2017, All rights reserved.