# Bedrooms:		# of full and 1/2 Baths:
Coverages:
Dwelling Cov. $		Deductible: Select Ded. $250 DED $500 DED $1000 DED $2500 DED
Select Contents Coverage:		60% of Dwelling Amt. 75% of Dwelling Amt.
Select Liability Coverage:		$100,000 $300,000
Select Coverage Type:		Replacement Value Actual Cash Value
Comments/Remarks (describe any scheduled jewelry, in-home business, swimming pool, barn, or other special coverages/remarks here):
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