Insured Name and Contact Information
Building and Insurance Information
or or
Overlying Deductible: (please select one ) All WindNamed Wind OnlyWind and Hail Only
Limit Applicable: (please select one ) Per OccPer LocaPer BldgPer Bldg/Per OccPer Loca/Per Occ
Construction Type: (please select one ) Brick VeneerFire ResistiveFrameJMMNCNC
Year Built: (please select one ) Post 20052002-20051994-2001Pre 1994
Age of Roof: (please select one ) 0-2 Yrs.2-4 Yrs.4-8 Yrs.8-10 Yrs.10-12 Yrs12-15 Yrs.15-20 Yrs20+ Yrs.
Type of Roof: (Please select one) UnknownShingleMetalTileSlate
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