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    Personal Articles Application / Binder-Receipt

    Uploaded by

    Rachel Piper
    Rachel Robinson applied for personal articles insurance through State Farm to insure $7,188 worth of jewelry. The application was submitted on April 5, 2017 and listed her address as 200 E 15th St Apt 17 in Oakland, CA. State Farm agreed to provide coverage for up to 90 days from the effective date for a premium of $117, which Rachel Robinson paid. The agent was Joe Freund of J Freund Ins and Fin Svc Inc located in San Francisco.

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    Personal Articles Application / Binder-Receipt

    Uploaded by

    Rachel Piper
    223 views2 pages
    Rachel Robinson applied for personal articles insurance through State Farm to insure $7,188 worth of jewelry. The application was submitted on April 5, 2017 and listed her address as 200 E 15th St Apt 17 in Oakland, CA. State Farm agreed to provide coverage for up to 90 days from the effective date for a premium of $117, which Rachel Robinson paid. The agent was Joe Freund of J Freund Ins and Fin Svc Inc located in San Francisco.

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    Binder of Insurance

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    Rachel Robinson applied for personal articles insurance through State Farm to insure $7,188 worth of jewelry. The application was submitted on April 5, 2017 and listed her address as 200 E 15th St Apt 17 in Oakland, CA. State Farm agreed to provide coverage for up to 90 days from the effective date for a premium of $117, which Rachel Robinson paid. The agent was Joe Freund of J Freund Ins and Fin Svc Inc located in San Francisco.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    223 views2 pages

    Personal Articles Application / Binder-Receipt

    Uploaded by

    Rachel Piper
    Rachel Robinson applied for personal articles insurance through State Farm to insure $7,188 worth of jewelry. The application was submitted on April 5, 2017 and listed her address as 200 E 15th St Apt 17 in Oakland, CA. State Farm agreed to provide coverage for up to 90 days from the effective date for a premium of $117, which Rachel Robinson paid. The agent was Joe Freund of J Freund Ins and Fin Svc Inc located in San Francisco.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    State Farm General Insurance Company Applicant Name: ROBINSON, RACHEL

    Binder Effective Date: 04-05-2017


    CA Personal Articles
    Application / Binder-Receipt 05-CX-M271-5 G

    NEW BUSINESS
    APPLICANT: ROBINSON, RACHEL
    MAILING ADDRESS: 200 E 15TH ST APT 17 PROPERTY LOCATION: 200 E 15TH ST APT 17
    OAKLAND CA 94606-1793 OAKLAND CA 94606-1793
    BILLING:
    Put application on SFPP: No

    COVERAGES / PREMIUM:
    Jewelry Deductible: Full Coverage
    Computer Deductible:
    Class of Property Inflation Coverage Limits of Liability Rate Premium

    Jewelry Yes $7,188

    OPTIONAL COVERAGES / PREMIUM:


    Inflation Coverage (Option I)
    Total Premium: $ 117.00
    Amount Paid: $ 117.00
    Credit Amount: $ 0.00
    Balance Due: $ 0.00

    UNDERWRITING:
    Has the applicant or any household member had any losses, insured or not, in the past 3 years: No
    Has any insurer or agency canceled or refused to issue or renew similar insurance to the named applicant or any household member within the
    past 3 years: No
    Has the applicant been convicted of arson, fraud, or other insurance related offenses: No

    APPLICANT(S) ACKNOWLEDGEMENT:
    By submission of this application, you agree that: (1) You have read this application, (2) your statements on this application are correct, (3) the
    coverages, including options and endorsements, and the amounts of coverage on this application are those chosen by you, (4) the premium
    charged must comply with State Farm's rules and rates and may be revised, (5) State Farm has the option of repairing or replacing any lost
    or damaged property, and (6) in the event of a cash settlement, you will be paid no more than State Farm's cost to replace the item.
    (This does not apply to Fine Arts.)

    BINDER:
    State Farm will provide coverage to the applicant and his or her legal representative on the property described for up to ninety (90) days from the
    Effective Date, subject to all terms and conditions of the policy and endorsements for which application has been made. If no Effective Date is
    indicated, this Binder does not provide any coverage. This Binder will be void when the declarations page is issued on the policy for which
    application has been made or when coverage under this Binder is canceled in accordance with policy provisions.

    The premium due State Farm for the coverage provided by this Binder will be the full annual premium for the policy for which application has been
    made, and will be pro-rated for the length of time coverage is provided under this Binder.

    AGENT INFORMATION:
    App date and time: 04-05-2017 12:55 PM
    Agent: Joe Freund Agent / AFO Code: 05-0180/02FAF2 Agent Phone: (415)359-9311
    J Freund Ins and Fin Svc Inc

    Location Address: 1734 Divisadero St


    San Francisco, CA 94115-3012

    IMPORTANT NOTICES

    REGARDING CONSUMER REPORTS...


    Consumer reports may be ordered in conjunction with this application. These reports provide information that assists with determining your
    eligibility for insurance.

    EB 2630 CA.3 Rev. 03-2017 Page 1 of 2 1003216 2009 140426 209 12-15-2015
    State Farm General Insurance Company Applicant Name: ROBINSON, RACHEL
    Binder Effective Date: 04-05-2017
    CA Personal Articles
    Application / Binder-Receipt 05-CX-M271-5 G

    REGARDING PERSONAL, FAMILY OR HOUSEHOLD INSURANCE TRANSACTIONS...


    We may collect personal information from persons other than the individual or individuals applying for coverage. Such personal information as well
    as other personal or privileged information subsequently collected may, in certain circumstances, be disclosed to third parties without your
    authorization as permitted by law. If you would like additional information about the collection and disclosure of personal information, please contact
    your State Farm agent. You may also act upon your right to see and correct any personal information in your State Farm files by writing your State
    Farm agent to request this access.

    EB 2630 CA.3 Rev. 03-2017 Page 2 of 2 1003216 2009 140426 209 12-15-2015

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