NEW YORK PROPERTY INSURANCE UNDERWRITING ASSOCIATION

PREMIUM QUOTATION DWELLING  BROAD FORM

CITY \ BOROUGH CONSTRUCTION OCCUPANCY COVERAGE
PERIL DESCRIPTION PROTECTION CLASS DEDUCTIBLE SEASONAL
NO. OF FAMILIES INSURANCE AMOUNT INFLATION GUARD OTHER CREDITS 
   DESCRIPTION    
     AMOUNT   
  PREMIUM
TOTAL PREMIUM:
 


NOTE:ALL POLICIES ARE SUBJECT TO A $50 MINIMUM PREMIUM
Important: 2% catastrophe windstorm deductible applies to the following territories:
Bronx, Brooklyn, Queens, Staten Island, Nassau, Suffolk, and Westchester
(including Mount Vernon, New Rochelle and Yonkers)