Evidence of Property Insurance & Invoice Instructions

Evidence of Property Insurance & Invoice Instructions

(California Version)

All the fields have to be completed.
CA Evidence of Property Insurance use form 62 6500 CA 05012013.
CA Property Insurance Invoice use form 61 6513 CA 05012013.
Details for each field in EOI (62 6500 CA 05012013):

Field(s) / What included / How to use
Company Name/NAIC# / Company name and NAIC#:
1)CA HO (HO3, HO4, HO6) and PUP: please choose “CSAA Insurance Exchange[NAIC#15539]”
2)DP3: please choose “CSAA Fire & Casualty Insurance Company [NAIC#10921]” / Select from a drop-down list
Agent / Please fill in the following information:
1)Agency/Club Name
2)Agency/Club Address Line 1
3)Agency/Club Address Line 2 (if applicable)
4)Agency/Club City, ST, Zip / Must be filled in by the user
Agent Name / Name of agent / Must be filled in by the user
Phone # / Phone # of the agency/club / Please fill in your own phone #
Company / 1)Please choose company name (same as the company name on the top)
2)Company address is static; not changeable field / Select from a drop-down list
Notice Date/Time / Date and time of this form generation / Select from a calendar; Time must be filled in by the user
Insured / Please fill in the following information:
1)Applicant first name, middle initial and last name
If user selects to use “Legal Name” for this form, the Legal Name must be typed in by the user
A dynamic Legal Description Disclosure checkbox appears at the bottom of this form. User must also check this checkbox
2)2nd Named insured’s first name, middle initial and last name, if 2nd named insured is present
3)3rd Named insured’s first name, middle initial and last name, if 3rd named insured is present
4)4th Named insured’s first name, middle initial and last name, if 4th named insured is present
5)Insured mailing address line 1
6)Insured mailing address line 2, if present
7)Insured mailing city, state and zip / Must be filled in by the user
Policy # / 1)Same policy # in PAS
2)Please include policy prefix
3)Format: AZH3-999999999 / Must be filled in by the user
Policy Period / Policy effective date and expiration date / Must be filled in by the user
Location of Insured Property / 1)Insured physical address line 1 and line 2 (if present)
If user selects to use “Legal Property” for this form, the Legal Property Address must be typed in by the user
A dynamic Legal Description Disclosure checkbox appears at the bottom of this form. User must also check this checkbox
2)Insured physical address line 2, if applicable
3)Insured physical city, state and zip / Must be filled in by the user
Coverage / 1)Coverage A – Dwelling applies to HO3, HO6 and DP3 only
2)Coverage B – Other Structures applies to HO3 and DP3 only
3)Coverage D – Loss of Use applies to HO3, HO4 and HO6
4)Coverage D – Fair Rental Value applies to DP3
5)Above fourcheckbox(es) must be checked due to product
6)Coverage C – Personal Property, Coverage E – Personal Liability and Coverage F – Medical Payments to Others should always be checked / Select the checkbox(es)
Amount of Insurance / Amount of each coverage / Must be filled in by the user
Policy Type / 1)HO3 – Homeowners
2)HO4 – Renters
3)HO6 – Unit-owners
4)DP3 – Rental Property / Select from a drop-down list
Annual Premium / Annual term premium for the current term / Must be filled in by the user
Deductible / Policy deductible / Must be filled in by the user
Occupancy / This field only applies to HO6. Other products please choose “Not Available”.
1)Owner-occupied
2)Vacant/Unoccupied
3)Tenant-occupied / Select from a drop-down list
Paid in Full / 1)When the policy is paid in full, please check the checkbox
2)When the policy is not paid in full, please leave the checkbox unchecked
3)Type in the full payment received date “MM/DD/YYYY” when the policy is paid in full
4)Leave Blank when the policy is not paid in full / Select the checkbox; Full payment received date must be filled in by the user
Remarks / 1)If extended replacement cost endorsement is added into the policy, the following checkbox(es) must be checked:
HO3 selects “HO-28 Limited Home Replacement Cost Endorsement 150%”
HO4 selects “None”
HO6 selects “HW-28 Limited Home Replacement Cost 150%”
DP3 selects “DW 04 20 12 05 Limited Replacement Cost Endorsement 125%” or “DW 04 20 12 05 Limited Replacement Cost Endorsement 150%” whichever is attached to the policy
2)If HO 17 33 is attached to the policy, the checkbox of “HO 17 33 Unit Owners Rental to Others” must be checked
3)If 438BUNS is added into the policy, the checkbox if “438BUNS – Lender’s Loss Payable Endorsement” must be checked / Select the checkbox; Select from a drop-down list
Mortgagees and Other Interests / 1)Only active Interests should be selected:
Mortgagee
Additional Insured
Additional Interest
2)If the policy has no interest/mortgagee listed, “None” must be selected
3)Interest name line 1
4)Interest name line 2, if applicable
If user selects to use “Legal Property” for this form, the Legal Property Address must be typed in by the user
A dynamic Legal Description Disclosure checkbox appears at the bottom of this form. User must also check this checkbox
5)Interest address line 1
6)Interest address line 2, if applicable
7)Interest #2 city, state and zip
8)If more space is needed for Mortgagees and Other Interests please continue using 2nd page; Display interests according to the requirements listed for this field on 1st; Otherwise, please delete the 2nd page / Select from a drop-down list; Interests information must be filled in by the user
Loan # / Interest loan # populated from PAS / Must be filled in by the user
Legal Description Disclosure / If Legal Insured Name, Legal Property Address or a Legal Additional Interest Name is entered to this form, this checkbox must be checked; Otherwise, leave this checkbox unchecked / Select the checkbox
Authorized Representative / User must sign this form if requested by the mortgagee/insured / Must be filled in by the user

Details for each field in Invoice (61 6513 CA 05012013):

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