Policy Limits	Policy A	Policy B	Policy C
Amount of personal property coverage (List amount)
Amount of deductible
Policy limits on high-value items: (List limits)
Jewelry, watches, furs
Guns
Silverware, goldware
Money, coins, gold, silver
Stamps, securities, valuable papers (List percentage of policy limits)
Coverage on property at another residence (List percentage of policy limits)
Liability coverage: (List dollar amounts)
Personal liability:
Damage to property of others
Medical payments
Policy Coverages	Policy A	Policy B	Policy C
Does quote include the following? (List dollar limits quoted or ‘NI’ if coverage is not included in quote)
Replacement cost coverage
Personal computer coverage
Waterbed liability
In-home business
Moving and storage
Other coverage quoted:
Policy Costs	Policy A	Policy B	Policy C
Basic premium for coverages listed above (List premium)
Premium if deductible is raised/lowered to: (List premium)
$
$
Additional Coverage and Discounts	Policy A	Policy B	Policy C
Does quote include additional premium for these items? (Answer yes or no) Premium for?
Replacement cost coverage
Increased limits for high-value items
Additional liability coverage:
$300,000
$500,000
Are discounts offered for these? (Answer yes or no)
Deadbolt locks
Smoke detectors
Security system
Being a non-smoker
Cost of Floaters for High-Value Items	Policy A	Policy B	Policy C
(Over and above limits listed above List rate per $100 valuation) Type of Floater:
Jewelry, watches, furs
Guns
Silverware, goldware
Money, coins, gold, silver
Stamps, securities, valuable papers

Updated Friday, July 23, 2004