| Coverage A |
| Dwelling and attached structures such as garages and decks |
| Current Limit |
Plan 1 Limit |
| $________ |
$________ |
| Coverage B |
| Other structures such as detached garages and sheds |
| Current Limit |
Plan 1 Limit * |
| $______ |
$______ |
| Coverage C |
| Personal property such as furniture and clothing |
| Current Limit |
Plan 1 Limit * |
| $________ |
$________ |
| Coverage F |
| Medical payments to others |
| Current Limit |
Plan 1 Limit |
| $________ |
$________ |
| Coverage D |
| Loss of use or access to your dwelling |
| Current Limit |
Plan 1 Limit * |
| $________ |
$________ |
| Coverage E |
| Personal liability for property damage and bodily injury to others |
| Current Limit |
Plan 1 Limit |
| $________ |
$________ |
| Deductible |
| Amount of a covered claim that is your responsibility |
| Current ALL PERILS |
Plan 1 ALL PERILS |
| $________ |
$________ |
| Current Wind/Hail |
Plan 1 Wind/Hail |
| $________ |
$________ |
| Additional Coverages |
current limit |
Plan 1 limit |
| Water Back Up and Sump Discharge or Overflow Coverage |
$________ |
$________ |
Personal Property Replacement Cost Loss Settlement
|
$________ |
$________ |
| Additional Replacement Cost Protection Coverage - Dwelling A |
$________ |
$________ |
| Jewelry Coverage |
$________ |
$________ |
* Your Coverage B, C, and D limits are maintained as a percentage of your Coverage A limit. If your Coverage A limit changes, your Coverage B, C, and D limits will be adjusted accordingly.
Coverage A - Dwelling