Homeowners Declarations Page
Policy Number: NYH0026559
NAMED INSURED YOUR AGENT
Sandra Williams MGW dba, Curran Cooney Agency
35 FLETCHER AVE 11 Powerhouse Road
Mt Vernon, NY 10552 Roslyn Heights, NY 11577
(516)484-5200
TRANSACTION SUMMARY
Policy Period: 10/05/2024 12:01 am to 10/05/2025 12:01 am Standard Time at insured location
Transaction Type: Endorsement
Effective Date of Transaction: 10/05/2024 12:01 am
Transaction Premium: $0.00
INSURED RESIDENCE PREMISES LOCATION
35 FLETCHER AVE
MOUNT VERNON, NY 10552-3329 Westchester
Coverage is provided where a premium or limit is shown for the coverage
SECTION I PROPERTY COVERAGES LIMIT
Coverage - A - Dwelling $936,000
Coverage - B - Other Structures $93,600
Coverage - C - Personal Property $655,200
Coverage - D - Loss of Use $280,800
SECTION II LIABILITY COVERAGES LIMIT
Coverage - E - Personal Liability $500,000
Coverage - F - Medical Payments To Others $5,000
In case of a loss under Section I, we cover only DEDUCTIBLE
DEDUCTIBLES that part of the loss over the deductible stated: AMOUNT
All Perils Other Than Hurricane: $1,500
Hurricane Deductible Percentage: N/A
Hurricane Deductible: $1,500
PREMIUM CHARGES, DEBITS, AND CREDITS PREMIUM
Homeowner Premium: $6,268.00
Premium Debits: $0.00
Premium Credits: ($1,319.00)
TOTAL PREMIUM: $4,949.00
FORMS AND ENDORSEMENTS LIMIT PREMIUM
Ordinance or Law Coverage 10% Included
HO 23 95 05 02 Off Premises Theft Exclusion Included
HO 04 46 10 00 Inflation Guard 4% Included
HO 04 20 10 00 Additional Amount of Insurance for Coverage A 25% $177.00
Loss Assessment Coverage $1,000 Included
Water Back-up and Sump Discharge or $5,000 Included
Overflow Coverage - New York
Personal Injury Included
NBICHODEC1219 PO BOX 9950 • Providence, RI 02940-4150 Page 1 of 3
Prepared on September 24 , 2024
Homeowners Declarations Page
Policy Number: NYH0026559
Identity Fraud Expense Coverage $15,000 Included
NBICNYMAR 08 14 Mariner Plus $172.00
NBIC HO EB 10 19 Equipment Breakdown Coverage (Deductible - $100,000 $32.00
$500)
HO 24 93 05 02 Worker Compensation- NY
IL N 001 09 03 Fraud Statement
HO 16 10 01 09 Water Exclusion Endorsement
NBIC NY SP 08 20 NY Special Provisions
NBIC VCE 12 21 Virtual Currency Exclusion
NBICCBIS 06 16 Notice on Credit Based Insurance Scores
NBICNJNYPOLEXC 04 13 Total Pollution Exclusion
HO 04 96 10 00 No sec. II Liab. Cov., Ltd. Sec. I Prop Cov. for
Home Day Care
NBICNYTPD 02 10 NY Third Party Designee
NBICPP 11 09 Privacy Policy
NBICWLCI 11 09 Claim Information
NBICWLFN 12 11 Notice on Flood Insurance
NBICWLHP 11 09 Hurricane Preparedness
NBICWLSP 11 09 ShelterPride
NBICWOD 02 15 Waiver of Deductible
HO 04 16 10 00 Premises Alarm or Fire Protection System
HO 00 03 10 00 HO3 Special Form
PREMIUM CREDITS AMOUNT
Deductible ($795.00)
At Home Credit ($147.00)
Protective Devices ($118.00)
Companion Policy ($259.00)
MORTGAGEE LOAN NUMBER
FREEDOM MORTGAGE - ISAOA/ATIMA 0092572130
PO BOX 5050
TROY, MI 48007-5050
ADDITIONAL INTEREST INTEREST TYPE
RATING CRITERIA
Protection Number of
Class Territory Tier Occupancy Families Year Built Construction
3 1707 6 Owner 2 1906 Frame
NBICHODEC1219 PO BOX 9950 • Providence, RI 02940-4150 Page 2 of 3
Prepared on September 24 , 2024
Homeowners Declarations Page
Policy Number: NYH0026559
THIS DECLARATION, TOGETHER WITH THE POLICY JACKET, HOMEOWNERS POLICY AND ENDORSEMENTS
ISSUED TO FORM A PART THEREOF (IF ANY), COMPLETES THE ABOVE NUMBERED HOMEOWNERS POLICY.
TO REPORT A CLAIM FOR ALL OTHER INQUIRIES, CONTACT YOUR AGENT
800.343.3375 (option 2, then 1) or MGW dba, Curran Cooney Agency
http://www.nbic.com/company/report-a-claim.aspx (516)484-5200
NBICHODEC1219 PO BOX 9950 • Providence, RI 02940-4150 Page 3 of 3
Prepared on September 24 , 2024
