Insurance Revised Property Acords

INSURANCE REVISED PROPERTY ACORDS

Insured / Applicant Information

Individual Corporation Partnership Trust

Property Location & Description

Property Type: Residential Commercial Condominium Vacant Other:

Policy Details

Coverages and Limits

Building Coverage — Limit:   Deductible:

Personal Property Coverage — Limit:   Deductible:

Business Income / Extra Expense — Limit:   Waiting Period (hours):

Ordinance or Law Coverage — Limit:

Exclusions & Endorsements

The following standard exclusions apply unless specifically endorsed on the policy. Applicant must acknowledge receipt of exclusions:

Wear, Tear, Rust or Corrosion

Mold, Fungi or Bacteria (unless specifically endorsed)

Flood (unless Flood coverage is selected and endorsed)

Earthquake (unless specifically endorsed)

Intentional or Criminal Acts by Insured

Mortgagee / Loss Payee / Additional Insured

Claims, Notices and Required Documentation

The insured agrees to provide prompt notice to the insurer of any loss or circumstance which may give rise to a claim. The insured shall preserve all records and provide documentation reasonably requested by the insurer in support of any claim.

Proof of ownership / Deed
Prior policy declarations
Recent photographs of property
Repair estimates or loss documentation

Declaration and Authorization

I, the undersigned, declare that all statements made in this Insurance Revised Property Acords are true and complete to the best of my knowledge. I understand that any material misrepresentation, omission or fraudulent statement may result in denial of coverage or rescission of the policy. I warrant that the information provided herein is accurate and reflects the true state of the risk as of the date of signature.

I authorize any insurer, agent, or administrator to obtain and disclose information relevant to the underwriting or servicing of this policy, including inspection reports, claims history and loss runs. I understand that such information will be used to evaluate underwriting, rating and claims decisions. I further authorize the insurer to order inspections of the insured property and to share inspection results with third-party reinsurers and auditors for the purpose of risk assessment.

By signing below I acknowledge receipt of the specified exclusions, endorse the listed coverages and endorse the policy details as set forth in this revised form. Acceptance of any proposed change or endorsement is subject to issuance of an official endorsement by the insurer and payment of any required premium adjustment.

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