Producer:  To open and close each panel click on the button to the right please. Thank you. You may also call...
Producer Number: 09678-29640-001-00001
Producer Name: STEVE VALENCIA
Agency Name: ATHENA INSURANCE AND FINANCIAL SERVICES
Agency Phone: 209-223-1870
Agency Fax: 209-223-3227

Applicant and Property:  NOTE: AZ, CA, ID, IO, OR AND TX ARE OUR ONLY STATES CURRENTLY
1. On renewal please bill to :
2. Are you a business or association?
2A. If, "yes" to "2" above Provide  Name, phone and e-mail
3. Last Name:
4. First Name:
5. Phone:
5. E-mail:
7. If Secondary applicant add, Last Name:
8. Secondary applicant Firs name:
The following represents the legal / descriptive address  
9. Property Address:
10.  
11. Postal Code
12. City
13. State
The mailing address if different than the property address? If yes provide mail address
14. Building description:
15. Is this your Principal Residence?
     

Policy:
1. Policy Type:

2. Waiting Period:
3. Effective date:

Mortgages:
  • First Mortgagee
  • Second Mortgagee
  • Loss Payee
  • Disaster Agency
Loan Number:  
First Mortgagee:  
   
Address: Check if foreign address
   
City:  
State  
Postal Code:  
Phone: Fax:
Loan Number:  
Second Mortgagee:  
   
Address: Check if foreign address
   
City:  
State  
Postal Code:  
Phone: Fax:
Loan Number:  
Loss Payee:  
   
Address: Check if foreign address
   
City:  
State  
Postal Code:  
Phone: Fax:
Loan Number:  
Disaster Agency:  
   
Address: Check if foreign address
   
City:  
State  
Postal Code:  
Phone: Fax:
     

Community:
Grand fathering Type:  
Current Community Information    
Community Number:  
Panel Number:  
Map Suffix:  
Flood Zone:  
Base Flood Elevation if known:  
County Name:  
 
If Applicable Grand fathering Information    
Community Number:  
Panel Number:  
Map Suffix:  
Flood Zone:  
     

Construction
Date of Construction Source:  
Date of Construction:  
Is the building in the course of construction?  
If under construction is it Walled and Roofed?  
Is the building over water?  
Is the building located on Federal Land?  
     

Building Use:
Occupancy:  
Building Use:  
Foundation:  
Number of Floors:  
Attached Garage:  
Condo Form of Ownership:  
Condo Description:  
Number of Units:  
Do you have Flood proofing or an Elevation Certificate?  
     
     
     
     
     
     
Coverage for Building - Contents
Replacement Cost: $  
Replacement Cost Ratio: %  
Building Coverage Amount: $  
Building Deductible Amount: $  
Content Coverage Amount: $  
Content Deductible Amount: $  
Location of Contents: if coverage request / purchased  
     
security code
Enter Security Code:

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