COMPANY ABZ
Homeowners Declarations Page
100 Main Street This is a description of your coverage.
An y where, USA 01234 Please retain for your records.
Date Issued: May 1, 2017 Policy Number: XXXX-XX-XX-XX
Coverage Period:
3-01-2018 to 3-1-2019
112:0l a.m. standard time at the address of the
named insured.j Comment'[1]: This item
demonstrated the time period of
Named Insured location of Insured Property which your homeowners policy was
in effect.
John D Sample and Jane A Sample 100 Smart Street
100 Smart Street Happyville, USA 12345
Happyville, USA 12345
Total Premium for the premium period
TOTAL $1,390
k;ovERAGES AND APPLICABLE DEDUCTIBLES! LIMITS PREMIUM Comment f2): Review to
(See policy for applicable terms, conditions & exclusions) understand the available coverages
under the policy. Review the policy
for applicable terms, condition,
Section I - Property Coverages
and exclusions.
Coverage A • pwelllng prot-ection (structure)j $200,000 $1044
Comment (3): This-section lists
• $1,000 all peril �eductibl
the amount of coverage your
dwelling (the home itself) has
Coverage B · pther structures protectiohL $20,000 under your homeowners insurance
• $1,000 all peril deductible policy.
Coverage C • personal property protection L $100,000 $104
Comment (4): The deductible rs
how much you pay out of pocket
• $500 deductible before your coverage kicks in. You
pay per Incident. You chose the
• Replacement value
deductible at the policy's inception.
\
Comment [SJ: .structures not
Coverage D - Loss of Use · �dditional living expense� $20,000 INCL
attached here is covered for up to
• Up to 12 months 10% of your dW.etllng coverag�.
Comment (6): [INCL) Included in
dweillng premium.
Additional coverages:
�ewer backu� $5,000 $40 Comment (7): Co)lers the contents
of your home. Generally, coverage
equals 50% to 70% of your dwelling
Rider -µewelry I $10,000 $100
' coJ1erage. You chose this at the
inception of policy.
Section II - Liability Coverages Comment (8): ALE - Covers ff your
home has a covered loss and you have
no choice but to seek temporary
Coverage E • Liability protection �3.00,000 .per occu rrenc� $42 lodging elsewhere. Typically coverage
is.10 to l0% of dwelling coverage.
Some Dec page just note the length of
coverage, such as "Up to 12 months."
Coverage F • �uest medical cover-ag� $5,000 per person $20
Comment (9): Adds additional
coverage for sewer backup. This
additional coverage section will
not be applicable to your claim for
If you elect to pay your premium in installments, you may be subject to an additional fee for each Installment. The fire damage. Keep in mind that your
homeowners insurance policy
fee amount will be shown on your billing statements and is subject to change.
declaration pay may have other
sections inapplicable to fire.
DISCOUNTS
Comment (10): Adds extra
Your premium reflects the following discounts on applicable coverage (s). coverage if the insured had
expensive jewelry. Most
Multi-policy Claim free Burglar alarm system Tile Roof homeowners insurance polices do
not include additional coverage
for jewelry. However, if yours does,
FORMS AND ENDORSEMENTS I this is where it would typically be
located on the declaration page.
�omputer eoverageJ Premium - $40 I
Comment (11]: This section is not
applicable to fire damage.
Mortgagee
Comment (12): This section is not
Super Fantastic Finance Company
applicable to fire damage.
200 Savings Way
Smartville, USA 00012 Comment (13): Some insurers 11st
discount amount,.and others do hot.
·,
Comment (14): Adds extra
coverage for your computersif
damaged. Most homeowners
insurance polices do not include
additional coverage for jewelry.
However, if yours does, this is where
it would typically be located on the
declaration page.
