Fair Plan Indication (P-Lines)

Fair Plan Indication

Personal Lines Only
Person Completing form*
The completed PDF form will be emailed to the email address associated with this person
Today's Date*

MonthDayYear
Date
Completed By (For Email Subject Line)*
Client Info:
What is the name of the 1st Named Insured*
Quotation Number*
Address Info:
Street Address*
City*
State*
Zip*
Policy Coverage Limits:
Dwelling Coverage:
Extended Dwelling Coverage (125%):
Other Structures:
Personal Property:
Loss of Use / Fair Rental Value:
Ordinance or Law Coverage:
Debris Removal:
Awnings:
Fences (Metal):
Fences (Other):
Plants Shrubs And Trees:
Total Insured Value (TIV): Must not exceed the total of 3 million since this is the maximum allowed coverage within a Fair Plan Policy
Policy Deductible Options:
Premium for $2500 Deductible*
Premium for $5000 Deductible*
Premium for $7500 Deductible*
Premium for $10,000 Deductible*
Premium for $15,000 Deductible*
Premium for $20,000 Deductible*
Type a question
* The coverage listed above can be adjusted and customized to your actual needs.
Notes:
Should be Empty: