Unformatted text preview: AMERICAN STANDARD INSURANCE COMPANY OF OHIO
5905 IRON GATE TRCE
CUMMING GA 30040-5801 February 12, 2018
6204 LAKEFIELD PL
JOHNS CREEK GA 30097-2372 Regarding your Renters Policy for your property at:
6204 Lakefield Pl Johns Creek GA 30097-2372 We appreciate your business Important policy information enclosed
41028-43216-61 Billing account number
654-170-625-09 Next payment of $24.86
Due 04/01/2018 Since 1927, American Family Insurance has made it our business to give our customers peace of mind by
providing excellent customer service and financial protection.
To help you become better acquainted with your new property insurance, we have enclosed your
declarations page, policy, endorsements, special notices and a copy of your original application describing
the protection you have purchased. Please review these items carefully.
As a reminder, your next payment of $24.86 will be due on 04/01/2018.
Thank you for placing your trust in American Family. We will work hard to ensure your satisfaction and
peace of mind. If you have questions about this information, please contact your agent listed below or call
us at 1-800-MY AMFAM (1-800-692-6326).
AMERICAN STANDARD INSURANCE COMPANY OF OHIO
Your American Family Agent is:
Jessica Marie Praskovich
5905 IRON GATE TRCE
CUMMING GA 30040-5801 LR 00 05 08 17 Agent phone: 1-678-965-3463
E-mail: [email protected] Page 1 of 1 41028-43216-61 Declarations
Please read your policy American Standard Insurance Company of Ohio
6000 American Parkway
Madison WI 53783 Named Insured(s)
3405 Sweetwater Rd Apt 313
Lawrenceville, GA 30044 Policy Information
41028-43216-61 For customer service and claims service
24 hours a day, 7 days a week
1-800-MY AMFAM (1-800-692-6326)
amfam.com Policy period
2/1/2018 to 2/1/2019 Billing account number
654-170-625-09 Total premium with discounts applied $298.32
Total premium if paid in full $277.44
Discounts Applied to this Policy
Fire Alarm System Discount
These discounts reduced your total premium by $8.82
Residence Premises Information
3405 Sweetwater Rd Apt 313
30044 Residence use
Primary Residence Residence type
Single Family Dwelling Section I - Property Coverage Limit need for print $15,000 Coverage C - Personal Property
Broad Named Perils
Coverage D - Loss Of Use
Building Additions And Alterations
Fungi Or Bacteria $4,500
$5,000 Section II - Liability Coverage
Coverage E - Personal Liability
Dangerous Dog And Exotic Animal Liability
Coverage F - Medical Expense Per Occurrence Limit
$2,000 Deductible(s) Amount Property Deductible
Named Storm Deductible $1,000
$1,500 Policy Forms and Endorsements
HO 80 04 01 14
AL 00 04 05 17
American Family Mutual Insurance Company, S.I. Amendatory Endorsement
HO 81 11 01 15
Georgia Amendatory Endorsement
HO 86 03 01 15
Dangerous Dog And Exotic Animal Liability Limit
HO 85 07 09 17
Marijuana Growing and Processing Exclusion Endorsement
HO 04 90 01 14
Personal Property Replacement Cost Coverage
HO 04 16 01 14
Premises Alarm Or Fire Protection System HO 80 14 09 17 Page 1 of 2 Index: GA 41028-43216-61 Endorsement Details
Dangerous Dog And Exotic Animal Liability Limit Limit
No Charge Important Information
Amounts of insurance:
Please review the coverage amount on your personal belongings. We recommend you have at least an
amount equal to the estimated cost to replace your personal belongings. Your insurance agent can help you
select the coverage amount that best suits your needs. Creating an inventory of your belongings can also help
you estimate their value. Visit for more information about renters insurance and our free,
Web-based home inventory tool, DreamVault.
Damage caused by flooding:
This policy does not cover damage to your property caused by flooding. Flood insurance is available for
properties within communities that participate in the National Flood Insurance Program (NFIP). The NFIP is a
federally backed flood insurance program, which is administered by Federal Emergency Management Agency
(FEMA), a federal government agency. American Family Insurance is a participating insurance carrier of the
NFIP Write-Your-Own program. If your community participates in the NFIP, your American Family agent can
assist you in obtaining flood insurance through the NFIP. Not all communities participate in the NFIP. However,
flood insurance may still be available even if you do not live in a participating community. Contact your
American Family Insurance agent or visit floodsmart.gov.
Jessica Marie Praskovich
5905 IRON GATE TRCE
CUMMING GA 30040-5801
Declarations are effective on the date shown. These declarations form a part of this policy and replace all
other declarations which may have been issued previously for this policy. If these declarations are
accompanied by a new policy, the policy replaces any which may have been issued before with the same
REPRESENTATIVE HO 80 14 09 17 President Secretary Page 2 of 2 Index: GA 41028-43216-61 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I.
A. When used in the policy, the words American Family Mutual Insurance Company now means American Family
Mutual Insurance Company, S.I.
B. The following provision is added:
1. MEMBERSHIP AND VOTING
While this policy is in force, each insured named in the Declarations is considered an owner or policyholder
and a member of the American Family Insurance Mutual Holding Company (AFIMHC) of Madison,
Wisconsin. As a member, you are entitled to one vote at all meetings either in person or by proxy. You can
only cast one vote regardless of the number of policies or coverage you purchased. If two or more persons
qualify as a member under a single policy, they are considered one member for purposes of voting. The
owner of a group policy will have one vote regardless of the number of persons insured or coverage
purchased. Fractional voting is not allowed. If you are a minor, any vote will be given to your parent or legal
2. ANNUAL MEETINGS
The Annual Meetings are held at the Home Office: 6000 American Parkway, Madison, Wisconsin, on the
first Tuesday of March at 2:00 P.M. Central Standard Time. Notice in this policy shall be sufficient
If any dividends are declared, you will share in them according to law and under conditions set by the Board
All other terms, agreements, conditions, and provisions remain unchanged. AL 00 04 05 17 Page 1 of 1 Index: GA 41028-43216-61 RENTERS FORM
TABLE OF CONTENTS
POLICY......................................................................... 1 CONDITIONS..............................................................12 AGREEMENT................................................................1 HOW WE SETTLE LOSSES.......................................14 DEFINITIONS................................................................1 SECTION II - LIABILITY COVERAGE.........................14
Coverage E - Personal Liability..............................14
Coverage F - Medical Expense..............................14 SECTION I - PROPERTY COVERAGE........................3
Coverage C - Personal Property..............................3
Coverage D - Loss Of Use.......................................5 EXCLUSIONS............................................................. 15 PERILS..........................................................................6 ADDITIONAL COVERAGE..........................................19 EXCLUSIONS............................................................... 7 CONDITIONS..............................................................20 ADDITIONAL COVERAGE............................................9 GENERAL CONDITIONS............................................20 POLICY
This policy is a legal contract between you and us. Your policy consists of the DECLARATIONS, the RENTERS
FORM, all ENDORSEMENTS, and your INSURANCE APPLICATION. The policy details the rights and duties of
you and us. READ YOUR POLICY CAREFULLY. AGREEMENT
We agree with you, in return for your premium payment, to insure you subject to all the terms of this policy. DEFINITIONS
The following definitions apply throughout this policys form and endorsements. Defined terms are in bold type and
have the same meaning whether in the singular, plural, or any other form.
A. You and your mean a named insured shown in
the Declarations or, if living in the same
1. a named insured's spouse; or
2. a person who has entered into a domestic
partnership or civil union with a named insured
if such partnership or union:
a. is recognized under the laws of the state in
which a named insured resides;
b. grants equivalent rights and responsibilities
to its members as those granted to a
spouse under state law; and
c. has been registered with or filed with the
state or local government responsible for
recording such partnerships or unions.
B. We, us, and our mean the company shown in the
Declarations which provides this insurance.
C. In addition, we define these words and phrases:
1. Actual cash value. This means the least of
a. value of damaged property;
b. change in value of damaged property
directly due to the loss;
c. cost to repair damaged property; or HO 80 04 01 14 Page 1 of 22 d. cost to replace damaged property;
less a deduction that reflects depreciation, age,
condition, and obsolescence at the time of
Actual cash value may be significantly less
than replacement cost.
2. Bodily injury means physical injury, sickness,
disease, or death of any person. It includes
resulting loss of services, loss of consortium,
and required care.
3. Business means:
a. a full-time, part-time, or occasional
b. any other activity engaged in for money or
any other type of revenue, except the
(1) volunteer activities for which the only
payment received is for expense
incurred to perform the activity;
(2) selling energy generated on the
residence premises back to a public
(3) providing home day care services for
which no revenue is received, other
than the mutual exchange of such
(4) providing home day care services to a
relative. 41028-43216-61 4. Declarations. This means the pages showing
your coverage, limits, covered property,
premiums, and other information for this policy.
This includes all POLICY CHANGE documents
that apply to this policy.
5. Domestic employee means a person you
employ to perform only domestic duties:
a. including those necessary to clean,
maintain, or help enable the use of the
residence premises; or
b. at other locations for you or any insured;
only if such person is your employee per the
United States Tax Code.
This does not include any person while
performing duties for any insured's business.
6. Endorsement. This means a form that
changes, adds, reduces, or removes the terms,
conditions, or coverage of this policy.
7. Fungi. This means any type or form of fungus.
This includes but is not limited to mold or
mildew, and any mycotoxins, spores, scents, or
by-products produced or released by fungi.
8. Household. This means the persons who are
residents of the housing unit that you rent.
9. Housing unit. This means the living quarters
where you reside on the residence premises.
a. This means:
(1) you; or
(2) a household member who is:
(a) a relative; or
(b) under the age of 21 and in your
care or the care of a household
member who is a relative.
b. This also means under Section II of this
(1) a person you give your permission to
have custody of or to use:
(a) a vehicle or watercraft covered by
this policy; or
(b) an animal owned by an insured
described in 10.a. above;
when such custody or use is not in the
course of any type of business
(2) a person while working as a domestic
employee of an insured described in
Each person described above is a separate
insured under this policy. This does not
increase any limit in this policy. Each limit is
the most we will pay for any loss or
occurrence regardless of the number of
insureds or claimants involved, persons
injured, claims made, or suits brought.
11. Insured location means:
a. the residence premises;
b. if you notify us within 30 days of
acquisition, the part of a residential HO 80 04 01 14 premises you acquire as your new
residence during the policy period;
c. a premises you use in connection with the
d. any part of a premises:
(1) not owned by or leased to an insured;
(2) where an insured is temporarily
e. land that an insured owns, rents, or leases
that is vacant land.
Vacant land may contain structures
including fences, that are not buildings or
swimming pools, only if such structures
are for the personal use of an insured.
Vacant land does not mean any:
(2) land used for business; or
(3) land on which any:
(a) structure; or
designed or used for farming or
f. land that an insured owns, rents, or leases
on which a one or two family dwelling is
being built as a residence for an insured;
g. individual or family cemetery plots or burial
vaults of an insured.
12. Limit. This means the most that we will pay
under any coverage. We do not have any
liability for any payment above any limit in this
a. This means farm animals including but not
limited to any:
b. Livestock does not mean any:
(1) domestic fowl, including any chicken or
duck, that is raised for consumption by
the household; or
(2) domestic pet, including a dog or cat.
14. Nuclear hazard. This means any type or form
of nuclear reaction, radiation, or contamination
however caused. This includes any direct or
resulting damage, regardless of whether the
nuclear reaction, radiation, or contamination is
caused by any:
a. act or failure to act; Page 2 of 22 41028-43216-61 15. 16. 17.
19. b. natural event; or
c. design, construction, care for, or use of
any nuclear facility, material, or device.
Occurrence means an accident, including
substantially the same general harmful
conditions, which results during the policy
a. bodily injury; or
b. property damage.
a. This means any contaminant or irritant
regardless if it is:
(1) man-made or natural;
(2) a solid, liquid, gas, compound; or
(3) thermal irritant.
b. This includes but is not limited to:
(1) lead, mercury, radon, asbestos,
(2) solvents, alkalis, acids;
(3) gasoline, diesel, alcohol, kerosene,
heating oil, or any other type of
petroleum based or bio-based fuel;
(4) garbage, refuse, other waste, material
to be recycled; or
(5) any substance any governmental
agency lists as a controlled chemical
or hazardous substance.
c. Pollutant does not mean:
decomposition of any animal; or
(2) a contaminant or irritant from a fire.
Property damage means physical damage to
or destruction of tangible property. This
includes loss of its use.
Relative. This means a person related to you
by blood, marriage, or adoption.
a. This means the:
(1) housing unit; and
(2) other parts of that location used or
household members for residential
at the residence premises location shown
in the Declarations.
b. Residence premises includes that part of
any other residence you do not own while
you are temporarily residing there because
the housing unit is being repaired,
renovated, or rebuilt and is unfit to live in. 20. Structure.
a. This means a man-made object requiring
site preparation of the earth to enable its
construction at a set location. A structure
must be a permanent and stationary part of
the realty. This includes a building
permanently attached to a concrete
foundation. This also includes a retaining
wall, walkway, or driveway.
b. Structure does not mean any type of hot
tub, whirlpool, or spa that is manufactured
for use above ground.
c. A pier, wharf, or dock is a structure only if
it is permanently attached into the earth
and not removed on a seasonal basis.
21. Uninhabited. This means you do not reside
at, have moved from, or vacated the housing
unit. This definition does not change
regardless of the presence of any personal
property that may be in the housing unit.
Uninhabited does not mean those instances in
a. we consent in writing to:
(1) your reason for not residing at, moving
from, or vacating the housing unit;
(2) the steps you take to safeguard the
residence premises; or
b. you are temporarily residing away from the
housing unit due to:
(1) work related travel;
(2) a vacation; or
(3) use of a seasonal home.
22. War. This means damage caused by or
resulting from any:
a. armed conflict by any state, country,
nation, or other governed entity;
b. insurrection, rebellion, or revolution;
c. destruction, seizure, or use of any type of
property for any military purpose; or
d. warlike act by any person, group, or
War also means any damage caused by any
nuclear weapon or device. This includes
accidental explosion of such weapon or device.
This includes any electromagnetic pulse
damage whether caused by nuclear explosion
or otherwise. SECTION I - PROPERTY COVERAGE
The limits for this Coverage are shown in the Declarations.
A. Coverage C - Personal Property.
1. We cover personal property owned or used by
an insured while it is anywhere in the world. HO 80 04 01 14 Page 3 of 22 At your request after a loss, and if not insured
by the owner, we will cover personal property
owned by: 41028-43216-61 a. others while the property is on the part of
exclusively by an insured; or
b. a guest or a domestic employee, while
the property is in any residence occupied
by an insured.
2. The limit for property away from the residence
premises is 10% of the Coverage C limit but
not less than $3,000 for personal property:
a. while such property is taken out of the
United States; or
b. that is usually located at an insured's
residence other than the residence
premises. This includes property of a
full-time student, who is an insured, at the
residence occupied by that student.
However, this limitation does not apply to an
insured's personal property in your newly
acquired principal residence in the United
States for 30 days from the time you begin to
move the property there.
This limit does not increase the Coverage C
3. Special limits apply to the types of property
listed below. These special limits do not
increase the Coverage C limit. The limit for
each type applies to the total of all property
within the type.
a. $300 is the total limit for:
(1) money, bank notes, bullion;
(2) checks, money orders;
(3) negotiable instruments;
(4) scrip, coins, medals;
(5) gold, silver, and platinum except
flatware, tableware, plaques, and
trophies made or plated with these
(6) stored value cards and smart cards.
b. $300 is the total limit for marijuana if
deemed legal by the state law of the
insured location. This limit includes such
substance in any form including all plants
and any equipment and material used to
grow or process marijuana.
c. $1,500 is the total limit for watercraft. This
includes their trailers, motors, equipment,
parts, and accessories. This does not
include scale models.
d. $1,500 is the total limit for any trailers that
are not used with watercraft.
e. $1,500 is the total limit for any scale
models of any type that can be used
outdoors. This includes their equipment,
parts, and accessories.
f. $1,500 is the total limit for:
(2) securities, accounts, deeds;
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