Homebuilders Xtra

Common Policy Declarations

Policy Number: Company Name:

NAMED INSURED & Mailing Address Producer’s Name & Address

General Policy Business Description:

Information
When Coverage Begins: 12:01 A.M. Local Time at NAMED INSURED’s Address

When Coverage Ends: 12:01 A.M. Local Time at NAMED INSURED’s Address

In return for the payment of premium, and subject to all the terms and conditions of this
Policy, the Company agrees to provide the insurance as stated in this Policy.

The premium for this Policy is indicated below next to the applicable Coverage Part(s).
Coverage Part

$
$
$
$
$
$
Total Premium: $
Total Assessments, Fees, Surcharges, Taxes: $
Total Amount Due: $
Minimum Earned Premium: $

Attached Forms
Information

Authorization Information Date: _________________

Authorized Representative: __________________________

These Declarations together with the Coverage Declarations, Common Policy Conditions and Coverage Conditions (if applicable),
Coverage Form(s) and Forms and Endorsements, if any, issued to form a part thereof, complete the above numbered policy.

ACE0901 (12/17) Page 1 of 3

 Policy OCCURRENCE Limit of Insurance

The most the Company will pay for LOSS in any one OCCURRENCE, regardless of the number of available coverages
under this Policy applicable to a LOSS, is $ .

The most the Company will pay for LOSS caused by or resulting from WINDSTORM in any one OCCURRENCE,
regardless of the number of coverages available under each individual coverage part under this Policy is $ .

The most the Company will pay for LOSS caused by or resulting from NAMED WINDSTORM in any one OCCURRENCE,
regardless of the number of coverages available under each individual coverage part under this Policy is $ .

The most the Company will pay for LOSS in any one OCCURRENCE for an individual coverage part is the Per
OCCURRENCE Limit of Insurance stated on the Declarations for that coverage part.

These Declarations together with the Coverage Declarations, Common Policy Conditions and Coverage Conditions (if applicable),
Coverage Form(s) and Forms and Endorsements, if any, issued to form a part thereof, complete the above numbered policy.

ACE0901 (12/17) Page 2 of 3

 Policy Annual Aggregate Sub-limits of Insurance

FLOOD

Notwithstanding the foregoing, and irrespective of the stated Limit of Insurance or Sub-limits of Insurance stated
elsewhere in this Policy, the most the Company will pay for LOSS caused by or resulting from FLOOD in any one
OCCURRENCE, and in the aggregate for all LOSS from all OCCURRENCES in any one Policy year, regardless of the
number of coverages available under each individual coverage part under this Policy is:

Per OCCURRENCE $

Annual Aggregate $

EARTH MOVEMENT

Notwithstanding the foregoing, and irrespective of the stated Limit of Insurance or Sub-limits of Insurance stated
elsewhere in this Policy, the most the Company will pay for LOSS caused by or resulting from EARTH MOVEMENT in any
one OCCURRENCE, and in the aggregate for all LOSS from all OCCURRENCES in any one Policy year, regardless of the
number of coverages available under each individual coverage part under this Policy is:

Per OCCURRENCE $

Annual Aggregate $

Pollution or Contamination Clean-Up

Notwithstanding the foregoing, and irrespective of the stated Limit of Insurance or Sub-limits of Insurance stated
elsewhere in this Policy, the most the Company will pay for the coverage provided under the Extension of Coverage for
Pollution or Contamination Clean-Up in any one OCCURRENCE, and in the aggregate from all OCCURRENCES in any
one Policy year, regardless of the number of coverages available under each individual coverage part under this Policy is:

Per OCCURRENCE $

Annual Aggregate $

FUNGUS, Wet Rot, Dry Rot or Bacteria

Notwithstanding the foregoing, and irrespective of the stated Limit of Insurance or Sub-limits of Insurance stated
elsewhere in this Policy, the most the Company will pay for the coverage provided under the Extension of Coverage for
FUNGUS, Wet Rot, Dry Rot or Bacteria in any one OCCURRENCE, and in the aggregate from all OCCURRENCES in any
one Policy year, regardless of the number of coverages available under each individual coverage part under this Policy is:

Per OCCURRENCE $

Annual Aggregate $

These Declarations together with the Coverage Declarations, Common Policy Conditions and Coverage Conditions (if applicable),
Coverage Form(s) and Forms and Endorsements, if any, issued to form a part thereof, complete the above numbered policy.

ACE0901 (12/17) Page 3 of 3