AAIS HOMEOWNERS POLICY DECLARATIONS PAGE

(May 2024)

 

 

The AAIS advisory HO 4921–Homeowners Policy Declarations page is available for a given insurer to file. It can be done along with changes to meet that insurer’s  needs and to comply with applicable state law. This form should be accurately completed since any discrepancy could have an adverse effect, such as a future dispute on a claim. This form is to be used with any of the HO policies.

General Information Section

The form’s first section contains spaces to provide the following information:

·         Insurance company name and mailing address

·         Agent/producer name and mailing address

·         Insurance policy number

·         Named insured and complete mailing address

·         Policy term, consisting of the inception and expiration dates, and the effective time (12:01 a.m., Standard Time or 12:00 noon, Standard Time) of coverage.

·         Described Location. A description of the covered property and the location. The description must be in enough detail to precisely identify the property’s location.

Property Coverages Section

COVERAGE AND LIMITS

The next section lists the property coverages and the limits of insurance that apply to the particular coverage. If a limit is not shown for a particular coverage there is no coverage.

·         Coverage A–Residence

·         Coverage B–Related Private Structures

·         Coverage C–Personal Property

·         Coverage D–Additional Living Cost and Loss of Rent

A deductible entry must be made that applies for Coverages A, B, C, D and their incidental coverages. The deductible applies to all perils except for any that might be listed on the deductible endorsement. Separate entries may also be made to trigger a theft and/or windstorm/hail deductible.

Liability Coverage

·         Coverage L–Liability coverage must have a per occurrence limit of liability entered.

·         Coverage M–Medical Payments to Others coverage must have two entries. The first is a per person limit and the second is the maximum payment in a single accident.

Other insured locations that apply only to Coverage L and Coverage can be entered in this area.

Incidental Property Coverages

The following coverages are provided in one of the listed forms. The defaulted limit within the coverage form can be modified by making an entry beside the coverage. If an entry is not made, the limit in the coverage form applies.

Additional Interests

All parties with a financial interest in the property are to be listed in this section. The name and mailing address must be entered.

Final Information