homeowners proposal of insurance for...insurance berkshire hathaway guard insurance companies...

Total Estimated Premium:

Effective Date: thru

Proposal Number:

Payment Terms:

Proposal of Insurance for . . .

Presented by

August 2017 Edition

Homeowners

Berkshire Hathaway

GUARD Insurance

Companies specialize

in providing

Property & Casualty

insurance coverage.

Nancy Burklow3548 Sherman St

Springfield, IL 62703-4855

$560.00

06/04/2019 06/04/2020

NAHO080789

20% down payment, 11 monthlyinstallment(s)

BEACON INSURANCE GROUP1919 Broadway Street

Mount Vernon, IL 62864

618-242-5411

Berkshire Hathaway GUARD Insurance Companies - P.O. Box A-H - Wilkes-Barre, PA 18703 - www.guard.com - phone: 1-800-673-2465

Total Estimated Premium:

Established:1983

Ultimate Parent:Berkshire Hathaway Inc.

Insurance Companies:AmGUARD, EastGUARD, NorGUARD, and WestGUARD

A.M. Best Company Rating:A+ (”Superior”); Financial Size Category X

CEO/President:Sy Foguel, ACAS, FILAA

Locations:Home office in PA; eight satellite offices across the United States

Specialty:Property & Casualty insurance

Products:*

For individuals, we feature Property coverage for:

� Homeowners

� Renters

� Condo Unit Owners

A Personal Umbrella is also available.

For businesses, we feature a commercial product suite that can generallyinclude one or more of the basic policies typically sought: Workers’Compensation, Property/Liability (via a Businessowner’s Policy),Commercial Auto, Commercial Umbrella, and/or Professional Liability.

Operating Area:Nationwide for commercial lines. We have also begun offering personalProperty and Liability coverage in select states. (Visit www.guard.comfor details.)

Performance:Combined loss and expense ratio (consistently under 100%) thatoutperforms our peer group

Distribution Network:Independent Insurance Agents

Number of Policies Issued (2017):256,000

Gross Written Premium (2017):$1.3 billion

Services:Full range of underwriting, loss control, billing, and claims value-addedservices provided that help policyholders realize the full benefit of theircoverage . . . in the easiest possible way

*Not all products are available in all states or through all subsidiaries.

GUARDBerkshire Hathaway

Companies

Insurance

Berkshire Hathaway GUARD Insurance Companies

BERKSHIRE

ATHAWAYH INC.

About . . .

Berkshire Hathaway GUARD Insurance Companies P.O. Box A-H, Wilkes-Barre, PA 18703 www.guard.com phone: 1-800-673-2465� � �

Quick Facts

AA Rating

Standard & Poor’s(as of 2017)

Fortune 500 #2(as of 2017)

S&P 500

Global 500 #8(as of 2017)

ChairmanWarren Buffett

More AboutBerkshire Hathaway – an

international holding companywith diverse interests that

include insurance andreinsurance – is regularlyrecognized as one of the

largest and strongestorganizations in the world.

I hereby authorize _____________________________________ to initiate pre-authorized debit transfers on

behalf of my business for (select one) , using to the information outlined below:� �one-time use ongoing

Policy(ies): ______________________________________________________________________________If this authorization applies to multiple policies, list all. For each, include the policy # and/or type (i.e., Comp, etc.); also, indicate new or renewal.

Name of Policyholder: _____________________________________________________________________

Bank Account #: ________________________________ Bank Routing #: __________________________

Bank Name: _____________________________________________________________________________Name City State

Preferred Start Date: ______________________ Amount (if one-time Direct Draft): ___________________

Statement Delivery Preference: Fax E-mail Mail Fax # or E-mail: _________________________� � �

(OPTIONAL) Attach a voided check to assist us in verifying your account information.

Authorized Signature: __________________________________________ Date Signed: ________________

Printed Name: ______________________________________

Phone Number: ______________________________________We send Billing Statements to give you advance notice of each draft amount as a courtesy to you.(The procedure for calculating premium is set forth in your policy.) We cannot guarantee that youwill receive this notice or that the notice will be received in advance of the Direct Draft. Regardless,payment is still due in accordance with your policy terms.

Attn:

DD

PF-T

B/8

-14

Ed10

Payment Terms:Your down payment is due in our office within ten (10) days of the effective date of your policy. Alwaysinclude your Proposal Number on all correspondence and checks. (Note: For policyholders that use escrow

accounts, we can arrange to have bills sent to the mortgagee.)

Payment Options:� CREDIT CARD: www.guard.comGo to the at to register and make yourPolicyholder Service Center

payment OR call Customer Service at . A fee may apply.1-800-673-2465

� DIRECT DRAFT: Complete the Authorization form (below) and fax to Accounting Services 570-820-7968OR make your Direct Draft payment from the at . NoPolicyholder Service Center www.guard.comInstallment fee applies with ongoing Direct Draft payments.

� E-CHECK: 570-820-7968Fax a copy of your completed check to . MARK THE CHECK FOR “DRAFT,”

making sure not to obscure the routing number, account number, or payment amount.

� TELEPHONE PAYMENT: 1-800-673-2465Call Customer Service at .

� MAIL PAYMENT: Make check payable toand include the remittance voucher (below).

See Direct Draft and Mailing Remittance Forms below.

MAILING REMITTANCE SLIP

Customer Name:

Agency Name:

Proposal Number:

Total Premium:

Down Payment Amount:

Mail Payment To:

Direct Draft Authorization:

GUARDBERKSHIRE HATHAWAY

INSURANCECOMPANIES

Nancy Burklow

Nancy Burklow

Nancy Burklow

NAHO080789

NAHO080789

CREDIT CARD: Go to the Policyholder Service Center at www.guard.com to register and make your paymentOR call Customer Service at 1-800-673-2465. A fee may apply.

DIRECT DRAFT: Complete the Authorization form (below) and fax to Accounting Services at 570-820-7968OR make your Direct Draft payment from the Policyholder Service Center at www.guard.com. No Installmentfee applies with ongoing Direct Draft payments.e-CHECK: Fax a copy of your completed check to 570-820-7968. MARK THE CHECK "FOR DRAFT," makingsure not to obscure the routing number, account number, or payment amount.

TELEPHONE PAYMENT: Call Customer Service at 1-800-673-2465.MAIL PAYMENT: Make check payable to Berkshire Hathaway GUARD Insurance Companies and includeremittance voucher (below).

BEACON INSURANCE GROUP

$560.00

$112.00

Berkshire Hathaway GUARD Insurance CompaniesATTN: Accounts ReceivableP.O. Box A-H - 39 Public SquareWilkes-Barre, PA 18703-0020

Berkshire Hathaway GUARD (WestGUARD Insurance Company)

(Note: For policyholders that use escrow accounts, we can arrange to have bills sent to the mortgagee.)

To: Proposal NAHO080789

570-825-9900

www.guard.com

Wilkes-Barre, PA 18703-0020P.O. Box A-H • 39 Public Square

Berkshire Hathaway GUARD

Proposal of Insurance Nancy Burklow

for 06/04/2019 to 06/04/2020 Prospect Number NAHO080789

This quote will expire on 06/05/2019.

Fax#: 866-468-5803 Fax Number: 570-820-7968Phone Number: 618-242-5411 Phone Number:

Extension: / e-mail: Ali Klein - Mount Vernon, IL

BEACON INSURANCE GROUP

The portion of the Total Estimated Cost attributable to terrorism premium is $ 0.00.

Total Estimated Cost: $560.00

Direct BillPayment Method:

Type of Coverage: Homeowners

AmGUARD Insurance CompanyCarrier:

(Direct billed policies will be charged a fee of $7.00 per installment.)

Information Needed to Issue:

Copies of any dec page(s) or policy number(s) to keep the Special Insurance Discount.*

A signed copy of the Mine Subsidence Rejection Form is required if Mine Subsidence Coverage is not desired.*

Important Notes:

* A Direct Draft electronic fund transfer option is offered which requires no installment fees and no checks to be mailed. A sign-up sheet is enclosed and can alternatively be downloaded from our web site at www.guard.com or obtained by contacting Customer Service at 800-673-2465.

* WE MAY, BUT ARE NOT OBLIGATED, TO INSPECT YOUR PROPERTY. THIS INSPECTION MAY BE MADE BY US or MAY BE MADE ON OUR BEHALF. AN INSPECTION or ITS RESULTING ADVICE, REQUIREMENTS or REPORT DOES NOT WARRANT THAT YOUR PROPERTY IS SAFE, HEALTHFUL, or IN COMPLIANCE WITH THE LAWS, RULES or REGULATIONS. INSPECTIONS or REPORTS, WHICH MAY INCLUDE PHOTOGRAPHS OF THE PROPERTY, ARE FOR INSURANCE PURPOSES ONLY.

* THIS COVERAGE DOES NOT PROVIDE ANY FLOOD COVERAGE- FOR FLOOD COVERAGE PLEASE SPEAK WITH YOUR AGENT.

Prepared: 05/29/2019 @Z

PROP-2/2008You may call Customer Service at 1-800-673-2465

- 24 hours a day, 7 days a week.

Page 1 of 6

Proposal of Insurance for Nancy Burklow (cont.)

3548 Sherman St, Springfield, IL 62703-4855

The next sections of this proposal list the various insurance coverages and limits included in this Homeowner's policy for the Total Estimated Cost shown above; some are automatically included while

others reflect specific requests.

SECTION I: Property

Coverages:

A. Coverage A - Dwelling

B. Coverage B - Other Structures

C. Coverage C - Personal Property

D. Coverage D - Loss of Use

Deductibles:

All Perils

Theft Deductible

Windstorm/Hail

186,527

0

93,264

55,958

1000

Same as All Peril

1%

SECTION II: Liability

300,000

3,000

E. Coverage E - Personal Liability Limit

F. Coverage F - Medical Payments Limit

Prepared: 05/29/2019 @Z



Page 2 of 6


SECTION III: Additional Coverages

Additional Coverage Selected: Limits:

Business Property

Off-Premises Limit 1,500

On-premises Limit 2,500

Coverage C - Other Residences

Limit 9,326

Coverage C - Self-storage Facilities

Limit 9,326

Coverage C - Special Limits of Liability

Jewelry, Watches and Furs Limit 1,500

Money Limit 200

Securities Limit 1,500

Silverware, Goldware & Pewterware Limit 2,500

Firearms Limit 2,500

Portable Electronic Equipment in or upon a motor Vehicle Limit 1,500

Credit Card, Electronic Fund Transfer Card or Access Device, Forgery and Counterfeit Money Coverage

Limit 1,000

Damage to Property of Others

Limit 1,000

Debris Removal

Limit 5%/1,000

Fire Department Service Charge

Limit 500

Grave Markers

Limit 5,000

Home Systems Protection Coverage

Limit 50,000

Landlord's Furnishings

Limit 2,500

Limited Fungi, Wet or Dry Rot or Bacteria Coverage

Section I Limit 10,000

Section II Limit 50,000

Mine Subsidence

Limit 750,000

Service Line Coverage

Limit 10,000

Supplemental Loss Assessment Coverage

Residence Premises Limit 1,000

Prepared: 05/29/2019 @Z



Page 3 of 6


Trees, Shrubs and Other Plants

Limit 5%/500

Water Backup & Sump Overflow

Limit 5,000

Section IV: Rating Characteristics

Form Code:

Construction:

Dwelling Type:

Occupancy Type:

Year Built:

Number of Families:

HO 03 - Special Form

Frame

PRIMARY

Owner Occupied

1955

1

Territory:

Protection Class:

Primary Roof Cover:

Roof Upgrade Year:

037

01

Composition - Architectural Shingle

2014

Prepared: 05/29/2019 @Z



Page 4 of 6


SECTION V: Policy Forms

Form Number Form Name

WELCOME LETTERHO WEL LET

GUARDIAN FLYERHO GUARDIAN

HOME OWNERS POLICY DECLARATIONSHO DEC 07 18

LIMITED HOME DAY CARE COVERAGE ADVISORY NOTICE TO POLICYHOLDERSHO P 004 05 11

Notice of Consumer Rights Under the Fair Credit Report ActHO FCRA

ADVISORY NOTICE TO POLICYHOLDERSHO P 063 10 15

Illinois Earthquake Insurance Availability NoticeHO PN IL 01 04 18

PRIVACY POLICYHO PRIV POL

FRAUD STATEMENTIL N 001 09 03

Illinois Notice to Policyholders Regarding the Religious Freedom Protection and Civil Union ActIL N 175 11 11

U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL ('OFAC') ADVISORY NOTICE TO POLICYHOLDERS

IL P 001 01 04

HOMEOWNERS 3 - SPECIAL FORMHO 00 03 05 11

WINDSTORM OR HAIL PERCENTAGE DEDUCTIBLEHO 03 12 05 11

LIMITED FUNGI, WET OR DRY ROT, OR BACTERIA COVERAGEHO 04 27 05 11

CREDIT CARD, FUND TRANSFER CARD, FORGERY AND COUNTERFEIT MONEY COVERAGEHO 04 53 10 00

LIMITED WATER BACK-UP and SUMP DISCHARGE or OVERFLOW COVERAGEHO 04 95 01 14

FUNCTIONAL REPLACEMENT COST LOSS SETTLEMENTHO 05 30 05 11

RESIDENCE PREMISES DEFINITION ENDORSEMENTHO 06 48 10 15

HOME-SHARING HOST ACTIVITIES AMENDATORY ENDORSEMENTHO 06 53 02 17

Special Provisions - IllinoisHO 112 01 04 18

MINE SUBSIDENCE RESIDENCE AND OTHER STRUCTURES - ILLINOISHO 23 88 06 12

MATCHING OF UNDAMAGED EXTERIOR SURFACING EXCLUSION DELETIONHO 99 78 03 18

LIMITED LOSS SETTLEMENT FOR WINDSTORM OR HAIL LOSSES TO ROOF SURFACINGHO 99 81 01 18

PROTECTIVE DEVICESHO 99 83 08 17

SERVICE LINE COVERAGEHO 99 89 06 17

HOME SYSTEMS PROTECTIONHO 99 90 06 17

Authorization and AttestationIL 99 00 08 13

Notice of Contact for ComplaintsPN IL 01 01 14

AIRCRAFT LIABILITY DEFINITION REVISED TO REMOVE EXCEPTION FOR MODEL OR HOBBY AIRCRAFTHO 34 02 02 17

Prepared: 05/29/2019 @Z



Page 5 of 6


PROPOSAL-05-29-2019-03 Accepted by:

Prospect's Signature:

Date:

DISCLAIMER This proposal/quote is not a binder. The Total Estimated Cost is based upon information provided to date and is subject to change even after coverage has been bound, based upon availability of additional pricing or underwriting information or considerations and/or upon the results of loss control surveys and compliance with recommendations. This summary of policy coverages, premium, and limits is not an insurance policy. For further details about the coverage, please review the policy forms and declarations pages. In the event of a conflict, the terms stated in the insurance policy shall govern. Please be aware that this proposal encompasses only the coverages listed and that those coverages are subject to the final terms and conditions stated in the policy. Our only offer of insurance is stated by the terms of this proposal, which can only be changed by our issuance of a new proposal.

Prospect Number: NAHO080789

Fax this signed proposal page to us at 570-820-7968

(print name)

Prepared: 05/29/2019 @Z



Page 6 of 6

ED1 (01/18)

Mine Subsidence Insurance Rejection Form

The Illinois Mine Subsidence Act (Article XXXVIIIA) requires that Mine Subsidence Insurance be available for any building in Illinois on policies providing fire and extended coverage beginning January 1, 1994. Coverage applies to direct physical loss of or damage to building. Additional details about the coverage can be provided by your agent.

If your insurance application is accepted by us and a policy is issued to you, Mine Subsidence coverage will be included. To reject this coverage, complete and return this waiver within 30 days of policy inception.

Reject Residence Premises ☐

I (We) do not desire Mine Subsidence coverage and hereby waive any right to such coverage under this policy or any future policy covering my (our) interest in the property identified above, unless I (we) request mine subsidence insurance coverage, in writing, at some future date.

_______________________________________________________ _______________________________ Policyholder/Applicant’s Name (Print) Policy Number

________________________________________________________ _______________________________ Policyholder/Applicant’s Signature Date

NAHO080789

3548 Sherman St, Springfield, IL 62703-4855

Auto Quote

Customer Information

Nancy Burklow3548 Sherman St Springfield, IL 62703-4855

Date Prepared: 05/28/2019

Proposed Policy Period: 06/04/2019 to 06/04/2020

Agent Information

BEACON INSURANCE GROUP INC 1919 BROADWAY ST MOUNT VERNON, IL 62864-2980

Phone Number: (618) 242-5411Email: [email protected]: www.beaconinsgroup.netAgent #: 250821

Call or email BEACON INSURANCE GROUP INC to start your protection with a monthly EFT down payment of $88.25.

PREMIUM SUMMARY PremiumVehicle Coverages $1,004.40Other Coverages $80.50Discounts & Safeco Safety Rewards Included

Your total policy premium for 12 months is $1,084.90

Your total policy premium for 12 months with the Paid in Full Discount is $985.10

Your total policy premium for 12 months with Automatic Bank Deduction is $1,035.10

DISCOUNTS & SAFECO SAFETY REWARDSAdvance QuotingViolation Free

Anti-Theft Coverage Homeowners Accident Free

DRIVER SUMMARYNancy Burklow - Rated

VEHICLE COVERAGES Limits / Deductibles

2017 Chry Pacifica

Bodily Injury Liability $100,000/$300,000 $215.00

Property Damage Liability $100,000 $176.40

Comprehensive $500 w/Full Glass $269.80

Collision $500 $343.20

Total Vehicle Premium $1,004.40

OTHER COVERAGES Limits / Deductibles PremiumMedical Payments $5,000 $33.80

Uninsured/Underinsured Motorist Bodily Injury $100,000/$300,000 $46.70

Accident Forgiveness Not Available --

This quote is provided without cost or obligation. It is not a contract or binder of coverage.

Safeco Insurance Company of Illinois

Auto Quote

Payment Options:

Automatic Deduction (EFT)

1. Full Payment $985.10 (Total Premium, no Installment Fee)

2. 2-Pay $494.55 (50% down payment + $2.00 Installment Fee)

3. 4-Pay $260.78 (3 months down payment + $2.00 Installment Fee)

4. Monthly Pay $88.25 (1 month down payment + $2.00 Installment Fee)

Recurring CC (RCC)




4. Monthly Pay $95.40 (1 month down payment + $5.00 Installment Fee)

Bill By Mail




4. Monthly Pay $185.82 (2 months down payment + $5.00 Installment Fee)

Safeco Insurance Company of Illinois

homeowners proposal of insurance for...insurance berkshire hathaway guard insurance companies...

Documents