(NEW) Process an EOI (P-Lines)

Process an EOI

Evidence of Insurance - Personal Lines Only
For Business Lines
Stop: This form is only used for Personal Lines, You can select Commercial Lines EOI if needed.
Producer & Agency Info:
Full Name of Agency/Organization*
Enter exactly as it appears on the agency license
Agency Address (Line 1)
Agency Address (Line 2)
Agency Phone Number*
Agency Email*
LSI address (Street Address)
LSI address (City, State, Zip)
LSI Agency Phone Number*
LSI Agency Email*
HRC address (Street Address)
HRC address (City, State, Zip)
HRC Agency Phone Number*
HRC Agency Email*
Rouland address (Street Address)
Rouland address (City, State, Zip)
Rouland Agency Phone Number*
Rouland Agency Email*
Searchlight address (Street Address)
Searchlight address (City, State, Zip)
Searchlight Agency Phone Number*
Searchlight Agency Email*
LA Metro address (Street Address)
LA Metro address (City, State, Zip)
LA Metro Agency Phone Number*
LA Metro Agency Email*
Person completing form (LSI)*
The completed PDF form will be emailed to the email address associated with this person
Person completing form (HRC)*
The completed PDF form will be emailed to the email address associated with this person
Person completing form (Rouland)*
The completed PDF form will be emailed to the email address associated with this person
Person completing form (Searchlight)*
The completed PDF form will be emailed to the email address associated with this person
Person completing form (LA Metro)*
The completed PDF form will be emailed to the email address associated with this person
Completed By (For Email Subject Line)
Today's Date*

MonthDayYear
Date
EOI being issued for*
Did you Bind Coverage*
NEVER release an EOI unless we have confirmation of binding.
STOP: Do not release this EOI. You must first bind the policy with the carrier then comeback to complete this EOI.
Client Info:
How many named insured will there be in the policy, therefore showing on the EOI. (This must match with request for EOI)*
Note: All the names will show on the evidence in the named insured area (box)
What is the name of the 1st Named Insured*
What is the name of the 2nd Named Insured*
What is the name of the 3rd Named Insured*
What is the name of the 4th Named Insured*
Carrier / Policy Info:
Name of the Insurance Carrier *
Company who is providing coverage for this property.
What is the Quote / Policy Number*
What is the Total Policy Premium*
Enter the total amount due including all fees
What is the Current Amount Due*
Enter the current amount due plus all fees
What is the effective date of the Policy (For new written policies)*

MonthDayYear
Date
What is the expiration date of the Policy (For new written policies)*

MonthDayYear
Date
Is there at least 6 months of coverage remaining on the policy prior to expiration date.
What was the last renewal date of this Policy (For existing active policies)*

MonthDayYear
Date
What is the expiration date of the Policy (For existing active policies)*

MonthDayYear
Date
Effective Date (for mapping)
Expiration Date (for mapping)
Note: Since most lenders/mortgage companies require there be at least 6 months remaining on the Policy, especially for a loan closing transaction. Therefore, the expiration date of the Policy will be extended for another 12 months.

Please remember to bill for the renewal premium when completing the invoice. Since we do not have the actual renewal premium then we simply take the current term premium plus an additional 10%. Any extra premium will simply be refunded to the customer.
Building Info:
Describe the Home*
How many policies are we writing to insure all the buildings /locations at this property location? Example- If there are two buildings and one is owner occupied and the other is tenant occupied, then it will be two policies.*
What is the adddress of Building No. 1?
Street
City
State
Zip
What is the amount of dwelling coverage - Bldg 1*
What is the amount of dwelling with extended replacement cost - Bldg 1*
What is the loss of use / loss of rents - Bldg 1*
What is the adddress of Building No. 2?
Street
City
State
Zip
What is the amount of dwelling coverage - Bldg 2*
What is the amount of dwelling with extended replacement cost - Bldg 2*
What is the loss of use / loss of rents - Bldg 2*
What is the adddress of Building No. 3?
Street
City
State
Zip
What is the amount of dwelling coverage - Bldg 3*
What is the amount of dwelling with extended replacement cost - Bldg 3*
What is the loss of use / loss of rents - Bldg 3*
What is the adddress of Building No. 4?
Street
City
State
Zip
What is the amount of dwelling coverage - Bldg 4*
What is the amount of dwelling with extended replacement cost - Bldg 4*
What is the loss of use / loss of rents Bldg 4*
Coverage Info:
What is the Policy Coverage/Peril Form*

BasicBroadSpecial
Total amount of Dwelling Coverage (All Buildings)*
Total amount of Dwelling w/ Extended Replacement Cost (All Buildings)*
Total amount of Loss of Use/Loss of Rents (All Buildings)*
Do we need to show / list the lender's loss payable endorsement on the EOI?*
The default is 438BFUNS, this can be deleted if escrow/title company does not want this listed.
What is the Deductible on the Policy*
Remarks:
Would you like to enter any verbiage/language that would appear in the remarks section of the EOI*
REMARKS (Including Special Conditions)*

Use the second line, if exceeded to 125 characters0/125
REMARKS (2nd line)

0/125
Additional Interest Info:
What is the name of the Additional Interest
What is the Additional Interest name continued (If any)
What is the Address of the Additional Insured
Street*
City *
State*
Zip *
How will this additional interest be listed in the EOI?*

Additional InsuredMortgageeLender's Loss PayableLoss Payee
What is the Loan Number*
Authorized Representative*
What is the Due Date*
Send to*
(Enter the name of the Company that requested the EOI)
Attention to*
(Enter the name of the Person that requested the EOI)
Should be Empty: