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MOBILE HOME INSURANCE
King Insurance Systems, Inc.
Local Agent Version
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Quote Prepared December 26th, 2000 at 6:28pm PST
| Proposed Insured's Information | |
| Applicant's Name: | Steve Repetti |
| Applicant's Age: | 40 |
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| Mobile Home Information |
| Tamarack Mobile Home, Built in 1990, Preferred Park, 500 Spaces |
| Construction Grade "S" - Standard - 24' x 60' = 1440 square feet |
| Orange County, Territory "A", Earthquake Zone 92692, Band "1" |
Guaranteed Replaced Cost,
Flood Coverage Included
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| Replacement Value | |
| Mobile Home: | $ 57,600 |
| Attached Structure Value: | $ 5,000 |
| --------------------------------------- | ------------- |
| Total Replacement Value: | $ 62,600 |
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| Earthquake Calculations | Rate | Premium |
| Base Rate w/ 15% Cov A Ded: | $ 2.13 | $ 133.00 |
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| Scheduled Personal Property | Coverage | Premium |
| Camera Equipment: | $ 500 | $ 10.00 |
| Fine Arts without Breakage: | $ 0 | $ 0.00 |
| Fine Arts with Breakage: | $ 0 | $ 0.00 |
| Golfers Equipment: | $ 650 | $ 7.00 |
| Guns: | $ 0 | $ 0.00 |
| Musical Instruments: | $ 2,500 | $ 14.00 |
| PC/Audio/Video Equipment: | $ 7,500 | $ 27.00 |
| Silverware: | $ 0 | $ 0.00 |
| Personal Jewelry: | $ 0 | $ 0.00 |
| Personal Furs: | $ 0 | $ 0.00 |
| Stamps: | $ 150 | $ 1.00 |
| Coins: | $ 300 | $ 6.00 |
| Antiques: | $ 0 | $ 0.00 |
| Other: | $ 500 | $ 8.00 |
| --------------------------------------- | ------------- | ------------- |
| Total Scheduled Personal Property: | $ 12,100 | $ 73.00 |
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| Optional Coverages | |
| Natural Disaster Protection: | $ 0.00 |
| Secured Interest Protection: | $ 0.00 |
| Additional Residence Premises Liability: | $ 0.00 |
| Golf Cart Coverage: | $ 35.00 |
| Wood Burning Stove: | $ 35.00 |
| Workers' Comp - Residence Employeee: | $ 0.00 |
| Loss Assessment: | $ 0.00 |
| Additional Limit for Radio and TV Antenna: | $ 25.00 |
| Additional Unattached Structures: | $ 0.00 |
| Additional Personal Effects: | $ 0.00 |
| Additional Personal Liability: | $ 0.00 |
| Scheduled Personal Property: | $ 73.00 |
| Sewer Backup: | $ 0.00 |
| --------------------------------------- | ------------- |
| Total Optional Coverages: | $ 168.00 |
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| Credits and Debits | |
| Lien Free Credit: | $ 0.00 |
| Flood - $250 Deductible: | $ 25.00 |
| Other: | $ 0.00 |
| Windstorm & Hail Exclusion: | $ 0.00 |
| Animal Liability Exclusion: | $ 0.00 |
| Protective Device Credit: | $ -10.00 |
| --------------------------------------- | ------------- |
| Total Credits and Debits: | $ 15.00 |
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| Coverages | |
| Replacement Cost Structures/Contents: | $ 62,600 |
| Unattached Structure Limit: | $ 6,300 |
| Loss of Use Limit: | $ 12,600 |
| Personal Effects Limit: | $ 31,500 |
| Personal Property Limit: | $ 12,100 |
| Personal Liability Limit: | $ 100,000 |
| Personal Medical Limit: | $ 1,000 |
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| Deductible | |
| Base Policy Coverage: | $ 250.00 |
| Flood Coverage: | $ 250.00 |
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| Policy Expenses | |
| Base Premium: | $ 271.00 |
| Optional Premium: | $ 168.00 |
| Credits and Debits: | $ 15.00 |
| Earthquake Premium: | $ 133.00 |
| Policy Fee (Fully Earned): | $ 55.00 |
| Broker's Fee: | $ 40.00 |
| --------------------------------------- | ------------- |
| Total Policy Expenses: | $ 682.00 |
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NOTE: THIS QUOTE IS PROVIDED FOR REFERENCE PURPOSES ONLY AND IN NO WAY BINDS ANY COVERAGE NOR GUARANTEES COVERAGE OR OBLIGATION OF ANY KIND.
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(c) 2000 by West Coast Web Adventures, Inc., All Rights Reserved
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