Preferred Flood Non-Binding Quote

FIRST COMMUNITY INSURANCE COMPANY

Quote Detail
Insured Effective - Expiration Date Quote Number
KEN PLANTS 09/08/2010 - 09/08/2011 39 QT90682543 99

Agency Detail
Agency PALADIN INSURANCE GROUP LLC (100930)
Address PO BOX 2295,
MURRELLS INLET, SC 29576-2295
Phone Number (843) 651-7111

Community Detail
Community 450085 GEORGETOWN COUNTY *
Flood Zone X

Property Detail
Property Address 4305 LOTUS CT UNIT D
UNIT D
MURRELLS INLET, SC 29576-4318
Building Replacement Cost $ 94,000
Occupancy Type Other Residential
Building Type Two Floors
Building Elevated No
Location of Contents Lowest Floor Above Ground Level and Higher Floors
Condominium Coverage Unit

Coverage & Premium Detail

Basic Limits Additional Limits Deductible
Total Amount Total
Coverage Amount of Annual Amount of Annual Premium
Rate Rate of Insurance Premium
Insurance Premium Insurance Premium Adjustment
Building 20,000 0.00 184 0 0.00 0 1,000 0 20,000 184
Contents 100,000 0.00 0 0 0.00 0 1,000 0 100,000 0
Annual Subtotal 184
ICC Premium 0
CRS Premium Discount 0 % 0
Probation Surcharge 0
Federal Policy Fee 20
Total Premium Due 204

Special Notes
THIS IS NOT AN OFFER FOR INSURANCE.
THIS QUOTE IS SUBJECT TO CHANGE WITH VERIFICATION BY THE COMPANY.

The online application process must be completed.

Please do not submit this form with your payment.
09/08/2010
Flood Non-Binding Quote

FIRST COMMUNITY INSURANCE COMPANY

Quote Detail
Insured Effective - Expiration Date Quote Number
KEN PLANTS 09/08/2010 - 09/08/2011 39 QT90682543 99

Coverage Rejection
I hereby certify that my agent offered primary flood insurance through FIRST COMMUNITY INSURANCE COMPANY. I
understand that because I declined to purchase this coverage, my agent will be held harmless and not liable in the event of a
loss.

I understand my rejection of this coverage will apply to all future renewals, continuations and changes unless I notify you
otherwise in writing.

I decline building coverage.

I decline contents coverage.

____________________________ ____________________________
Print Name of Insured Signature of Insured

____________________________ ____________________________ _____________

Print Name of Agent/Broker Signature of Agent/Broker License Number