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2023-03-22T17:37:26-07:00
Home Quote
Partnered with Rice Insurance
Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Property Address
*
singleLineAddressFieldName
Primary Use
*
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Home Details
Square Footage
*
This should not include the size of basement.
Replacement Cost
*
Stories
*
Please Select
1
1.5
2
2.5
3
3.5
4+
Bathrooms
*
Round up to the nearest whole number.
Year Built
*
Building Material
*
Please Select
Wood Frame
Stucco
Concrete
Log Home
Mobile Home
Roof Year Built
*
Roof Material
*
Please Select
Architectural
Three-Tab
Tile
Slate
Composition
Foam Rubber
Tar
Gravel
Metal
Polymer
Rolled
T-lock
Wood
Other
Roof Shape
*
Please Select
Complex
Flat
Gable
Gambrel
Hip
Shed
Other
Has A Basement?
*
No
Yes
Has A Garage?
*
No
Yes
Has A Swimming Pool?
*
No
Yes
Has Solar Panels?
*
No
Yes
Is This A Single Family Home?
*
Please Select
Yes, detached single family
Yes, attached single family(e.g. townhouse, row house)
No, duplex or two family
No, three family
No, four family
No, 5+ family
Is The Home Currently Insured?
*
Please Select
Yes
I do not yet own and not insured
I do own and not insured
Any Dogs
*
No
Yes
Any Dogs Over 25 LBS
*
No
Yes
Has Any The Dogs Ever Bitten or Attacked A Person?
*
No
Yes
Is Primary Heating Wood Stove?
*
No
Yes
Is There A Business With Customers On Site(Including Daycare)
*
No
Yes
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Home Coverages
Effective Date
*
/
Month
/
Day
Year
Policies can only be quoted up to 45 days in advance.
Do you have your auto insurance through Rice Insurance?
*
No
Yes
Main Dwelling Coverage
Guaranteed replacement of main dwelling structure up to $5 million automatically.
Coverage Percentage
*
Please Select
No Coverage
10%
25%
50%
75%
100%
Other Structures Coverage
Coverage B (Other Structures) Covers the cost to rebuild or repair other structures that are detached from your home.
Coverage Percentage
*
Please Select
No Coverage
10%
25%
50%
75%
100%
Personal Property Coverage
Coverage C (Personal Property) Covers the cost to replace your belongings (e.g. clothing and furniture).
Coverage Percentage
*
Please Select
No Coverage
20%
50%
100%
Loss of Use Coverage
Coverage D (Loss of Use) Provides living expenses while your home is being repaired (e.g. hotel expenses).
Coverage Limit
*
Please Select
$100,000
$300,000
$500,000
$1,000,000
Personal Liability Limit
Coverage E (Liability) Provides coverage for bodily injury sustained by others where you are responsible.
Other Structure Calc
Personal Property Calc
Loss of Use Calc
Standard Peril Deductible
*
Please Select
$500
$1,000
$2,500
$5,000
$10,000
$15,000
$25,000
$50,000
$75,000
Section 1 Deductible: The amount you will pay if a covered claim occurs.
Wind/Hail Deductible
*
Please Select
$500
$1,000
$2,500
$5,000
$10,000
$15,000
$25,000
$50,000
$75,000
Wind/Hail Deductible: The amount you will pay if a covered claim occurs that is caused by wind or hail.
Water Backup
*
Please Select
No Coverage
$5,000
$10,000
$25,000
$100,000
Full Coverage
Water Back-up Coverage for damage caused by water entering the home through a sewer or drain or resulting from a backedup drain or sump pump.
Equipment Breakdown
*
No
Yes: $100,000
Buried Service Lines
*
No
Yes: $10,000
Under Construction
*
No
Yes
Personal Cyber
*
No
Yes: $25,000
Home sharing Participation
*
Please Select
No
Yes, less than 10 days per year
Yes, 10-30 days per year
Yes, 31-90 days per year
Yes, 91-180 days per year
Yes, 180+ days per year
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Home Parties
Human Named Insureds
Person(s) who own the home.
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Additional Named Insured?
*
No
Yes
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Legal Entity Named Insured
Trust or LLC listed on deed to the home?
*
No
Yes
Name
Entity Type
Please Select
LLC
Trust
Other
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mortgagees
Any Lien-holders listed on the deed?
*
No
Yes
Bank Name
Interest
Please Select
ISAOA
ISAOA/ATIMA
ATIMA
-None-
Loan Number
Fax Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Payment & Bind-Request
Primary Contact
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Mailing Address
*
Do you give Openly permission to send text messages?
*
No
Yes
Do you accept electronic documents via Email? (Price is us to $25 lower for customers who select paperless)
*
No
Yes
Payment Plan
*
Please Select
Pay-in-Full
Pay-in-Full is the only payment plan available at this time.
Payment Method
*
Please Select
Electronic Funds Transfer(EFT)
Credit Card
Mortgage Escrow
2.99% Fee for Credit Card Payments
I verify that the above information is accurate to the best of my knowledge. I understand that coverage is not officially bound until I have received final approval from Rice Insurance and provided payment through the separate payment portal they send. I understand that if I misrepresented any details above that coverage will not be provided.
*
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