(NEW) Process an EOI (P-Lines)

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*

Person completing form (LSI)*

The completed PDF form will be emailed to the email address associated with this person

Completed By (For Email Subject Line)

Today's Date*

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)*

Date

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

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)*

Date

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

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 occupancy for Building No. 1

What is the Street Address

What is the City

What is the State

What is the Zip

What is the amount of dwelling coverage - Bldg 1*

What is the Extended Replacement Coverage

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 occupancy for Building No. 2

Street

City

State

Zip

What is the amount of dwelling coverage - Bldg 2*

What is the Extended Replacement Coverage

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 occupancy for Building No. 3

Street

City

State

Zip

What is the amount of dwelling coverage - Bldg 3*

What is the Extended Replacement Coverage

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 occupancy for Building No. 4

Street

City

State

Zip

What is the amount of dwelling coverage - Bldg 4*

What is the Extended Replacement Coverage

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

DWELLING / BUILDING COVERAGE*

Total amount of Dwelling Coverage (All Buildings)*

DWELLING WITH EXTENDED REPLACEMENT COST*

Total amount of Dwelling w/ Extended Replacement Cost (All Buildings)*

Loss of Use / Loss of Rents*

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*

The Total Cost of the Policy for the Term is:

REMARKS (Including Special Conditions)*

Use the second line, if exceeded to 125 characters0/125

REMARKS (2nd line)

0/125

Additional Interest Info: Note - you must do 1 EOI for each Additional Interest to appear on the form. However after hitting submit, you can edit submission and to simply add another additional interest.

Do you have any additional Interest to show on this EOI*

What is the name of the Additional Interest*

What is the Additional Interest name continued (If any)

Street*

City*

State*

Zip *

How will this additional interest be listed in the EOI?*

Will transfer title Property Management Co.

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)