PCA Policy Coverage Report
A sample of the "Policy Coverages" report from proClaimer Appraisal. This, and all report formats used in proClaimer Appraisal are copyright © 1982-2007 by Mik Ro Software, All Rights Reserved.
YOUR COMPANY NAME Our No. 13579-01
YOUR MAILING ADDRESS Assigned: 10/01/2001
YOUR CITY, TX 12345-6789 POLICY COVERAGES Contacted: 10/02/2001
123/456-7890 Inspected: 10/02/2001
FAX-123/456-7890 Report Date: 10/16/2001
Page No. 1
ATTN : Claims Examiner Insured: Billy Sheffield
Company : Anyone's Fire & Casualty 103 Ave Q
P.O. Box 333159 Apt 7B
Oklahoma City, TX 87531- Fort Worth, OK 76543-
Phone # : 817/972-8463
Claimant: Billy Sheffield
Policy #: AFC-5-A-8712-545 103 Ave Q
Claim # : AFC-545-011002 Location Apt 7B
CAT. # : of Loss: Fort Worth, OK 76543-
Agency : Anyone's Local Agency Type of Loss: Water Damage
Dallas, OK 75315- Date of Loss: 10/01/2001
Policy Coverages: HO-B, 101
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Description Coverage Amt TYPE Deductible Prev Pymts Pay Now Pay After
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Building/Dwelling $79,500.00 RC Y 0.00 0.00 $1,194.57 $321.23
Other Structure(s) $7,950.00 RC Y 0.00 0.00 $0.00 $0.00
Personal Property $35,000.00 RC Y 0.00 0.00 $0.00 $0.00
Additional Living Expens $15,900.00 ACV Y 0.00 0.00 $0.00
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Totals $138,350.00 0.00 0.00 $1,194.57 $321.23
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