Homepage Blank California Earthquake Authority PDF Form
Article Guide

The California Earthquake Authority (CEA) form serves as a crucial document for individuals seeking earthquake insurance coverage in the state of California. This application form gathers essential information about the applicant, including their name, contact details, and the physical location of the property to be insured. It also requires details about any co-applicants, if applicable. One of the key components of the form is the companion policy information, where applicants must provide specifics about their existing insurance policy, such as the name of the participating insurer and the policy number. The form outlines various types of coverage options available, including limits for dwelling coverage, personal property, and loss of use. Additionally, applicants must address important safety features of their property, such as whether the dwelling is secured to its foundation or if it has been inspected for prior earthquake damage. The form also allows for the selection of deductibles and additional coverage options, ensuring that applicants can tailor their insurance to meet their unique needs. Finally, the form concludes with a section for premium calculations and payment options, guiding applicants on how to manage their insurance costs effectively. Overall, the CEA form is designed to facilitate a smooth application process while ensuring that applicants are well-informed about their coverage choices.

Document Preview

Revised—Attachment A

 

Earthquake Insurance Application

Effective Date

 

Expiration Date

 

Applicant Information

 

 

 

 

 

 

 

 

Applicant

 

 

 

 

Telephone Numbers

 

 

 

Last Name

First Name

 

Middle I nitial

Home

 

Work

 

Co-Applicant (if applicable)

 

 

 

 

Telephone Numbers

 

 

 

Last Name

First Name

 

Middle I nitial

Home

 

Work

 

Street Address of Physical Location of I nsured Property

 

 

Mailing Address (if different)

 

 

 

 

Number and Street Address

 

 

Unit

Number and Street Address

 

 

 

Unit

City

State

ZI P Code

County

City

 

State

ZI P Code

Country

 

 

 

 

 

 

 

 

 

Companion Policy Information

 

 

 

 

 

 

 

 

Participating I nsurer

Companion Policy Number

 

Dwelling — Coverage A Limit

 

Expiration Date (must be same as CEA policy)

Type of Policy

 

 

 

 

 

 

 

 

Homeowner

Mobilehome / Manufactured Home

Condominium

 

 

Renters

 

Dwelling Fire

Other (explain in remarks)

 

 

 

 

 

 

Homeowner / Dwelling Fire

Mobilehome / Manufactured Home

CondominiumRenters

Rating Territory

Year Built

Number of Stories,

I ncluding Basement

Construction Type

 

Frame

Other

 

 

 

Number of Chimneys

 

 

 

 

 

 

Square Footage

 

 

 

 

 

 

 

Foundation Type

Raised

Slab

Other

 

 

 

Roof Type

Composition

Tile

 

Wood Shake

Other

 

 

 

Property I nspected?

Yes

No

Date

 

 

 

 

 

 

I s there unrepaired prior

Yes

No

earthquake damage to

 

 

the dwelling?

 

 

 

I f yes, DO NOT BI ND and explain in Remarks

 

 

 

 

Dwelling secured to

 

Yes

No

foundation?

 

 

 

 

 

 

 

Cripple walls braced with

Yes

No

plywood or equivalent?

 

 

 

 

 

Water heater secured to

Yes

No

building frame?

 

 

 

 

Dwelling — Coverage A

 

Dwelling Limit

$

 

 

 

 

 

Rating Territory

Construction Type

Mobile or Manufactured

 

 

 

Property I nspected?

Yes

No

Date

 

 

 

 

 

 

I s there unrepaired prior

Yes

No

earthquake damage to

 

 

the dwelling?

 

 

 

I f yes, DO NOT BI ND and explain in Remarks

 

 

 

Is the home reinforced by

Yes

No

an earthquake resistant

 

 

bracing system certified by

 

 

the California Department

 

 

of Housing and Community

 

 

Development?

 

 

 

I f yes, attach a copy of the certification

Dwelling — Coverage A

 

Dwelling Limit

$

 

 

 

 

 

Same as Companion Policy

 

 

Deductible

15%

 

10%

Personal Property — Coverage C

$5,000

$25,000

 

$50,000

$75,000

$100,000

 

 

No deductible for this coverage if Coverage A deductible is met. No coverage if Coverage A deductible is not met

Loss of Use — Coverage D

$1,500

$10,000

$15,000

 

No deductible for this coverage

 

Rating Territory

Number of Stories in building

Choose any combination of one or more

of the following options

Option One

Building Property — Coverage A

Real Property — $25,000

There is a $3,750 deductible for this coverage

Option Two

Personal Property — Coverage C

$5,000

$25,000

$50,000

$75,000

$100,000

 

There is a $750 deductible for this coverage

«AND »

Loss of Use — Coverage D

$1,500

$10,000

$15,000

No deductible for this coverage

Option Three

Loss Assessment — Coverage E

$25,000

$3,750 deductible

Only available if value of property is $135,000 or less

$50,000

$7,500 deductible

$75,000

$11,250 deductible

Rating Territory

Personal Property — Coverage C

$5,000

$25,000

$50,000

$75,000

$100,000

 

There is a $750 deductible for this coverage

Loss of Use — Coverage D

$1,500

$10,000

$15,000

 

No deductible for this coverage

 

Remarks

Same as Companion Policy

 

Deductible

15%

10%

Personal Property — Coverage C

$5,000

$25,000

$50,000

$75,000

$100,000

 

No deductible for this coverage if Coverage A deductible is met. No coverage if Coverage A deductible is not met

Loss of Use — Coverage D

$1,500

$10,000

$15,000

No deductible for this coverage

Additional Limited Building Code Upgrade

— optional —

I ncrease Limited Building Code Upgrade coverage from $10,000 to a total limit of $20,000

No deductible for this coverage if Coverage A deductible is met. No coverage if Coverage A deductible is not met

Premium Calculation

 

 

 

Payment Options

Base Premium

Increased Limits Premium

Hazard Reduction Discount

Total Premium

Annual

 

 

 

 

+

 

=

I nstallments

 

 

 

 

 

 

Homeowner and Mobilehome only

 

 

 

 

- if qualifications are met

 

 

Additional Interests

 

 

Send Bill To

 

Name

Loan Number

 

 

Mortgagee

 

 

 

I nsured

 

 

 

 

 

Additional I nsured

Address

 

 

Mortgagee

 

 

 

Loss Payee

 

 

 

 

City

State

ZI P Code

 

 

Name

Loan Number

 

 

2nd Mortgagee

 

 

 

I nsured

 

 

 

 

 

Additional I nsured Address

 

 

Mortgagee

Loss Payee

 

 

 

 

City

State

ZI P Code

 

I am applying for the insurance indicated, and the information on this application is correct

X

Applicant Signature

Producer Name and Address

Application Date and Time

Earthquake Application 05-09

Attachment A – Page 2

CALIFORNIA EARTHQUAKE AUTHORITY

EARTHQUAKE INSURANCE APPLICATION – 05/09 Edition

INSTRUCTIONS

POLICY EFFECTIVE DATE AND EXPIRATION DATE

Provide CEA policy effective date and expiration date. Expiration date MUST be the same as the expiration date of the companion policy.

APPLICANT

Complete all requested information for applicant(s) including: Name(s)

Telephone number(s)

Street address of physical location of insured property

Mailing address (if different from street address of property’s physical location)

COMPANION POLICY INFORMATION

Complete all requested information for companion policy including: Name of Participating Insurer

Policy number of companion policy

Dwelling limit (i.e., Coverage A) of companion policy (if companion policy has dwelling limit) Expiration date of companion policy

Type of companion policy

POLICY TYPE –RATING AND COVERAGE INFORMATION Identify CEA policy type based on the type of companion policy as follows:

Homeowner (Companion policy must be either a Homeowners (HO-1, 2, 3, 5, or 8), Dwelling Fire (building), Landlord (building), or Mobilehome policy.)

O MOBILEHOME/MANUFACTURED HOME (Written on CEA Homeowner Policy form; however, requires unique rating information.)

Condominium (i.e. Common Interest Development) (Companion policy must be a Condominium Unit Owners (HO-6) policy.)

Renters (Companion policy must be a Renters (HO-4) , Mobilehome (tenant policy), Dwelling Fire (contents only), or Landlord (contents only) policy.)

Complete all information requested under the applicable CEA policy type. Answer all questions and select desired CEA policy limits and coverage options.

PREMIUM CALCULATION

Provide premium calculations.

PAYMENT OPTIONS

Select payment option:

Annual; or

Installments

SEND BILL TO

Select who should receive the bill:

Insured; or

Mortgagee

ADDITIONAL INTERESTS

Complete information requested for each additional interest, including:

Type:

OMortgagee;

OAdditional insured; or

OLoss payee

Name and address

Loan number (if applicable)

REMARKS

Include any additional remarks as needed.

SIGNATURE

Secure the applicant’s signature on the application.

Provide the producer’s name and address.

Provide the date and time the application is completed.

Form Specifications

Fact Name Description
Governing Law The California Earthquake Authority operates under California Insurance Code Sections 10089-10089.16, which govern earthquake insurance policies in the state.
Application Purpose This form is used to apply for earthquake insurance coverage through the California Earthquake Authority, ensuring protection against earthquake-related damages.
Companion Policy Requirement Applicants must provide details of a companion policy, which is typically a homeowner's insurance policy that covers the dwelling.
Coverage Options The application allows for various coverage options, including personal property coverage and loss of use, with specific limits and deductibles outlined.
Inspection Requirement Property inspections may be required to assess the earthquake resilience of the dwelling, particularly if there is prior earthquake damage.

California Earthquake Authority: Usage Guidelines

Filling out the California Earthquake Authority form requires careful attention to detail. Make sure to provide accurate information to ensure your application is processed smoothly. Follow these steps to complete the form correctly.

  1. Policy Effective and Expiration Dates: Enter the effective date and expiration date of the CEA policy. Ensure the expiration date matches that of the companion policy.
  2. Applicant Information: Fill in all requested details for the applicant, including last name, first name, middle initial, and telephone numbers. Provide the street address of the insured property and the mailing address if different.
  3. Co-Applicant Information: If applicable, complete the same information for the co-applicant.
  4. Companion Policy Information: Include the name of the participating insurer, the companion policy number, the dwelling limit, and the expiration date of the companion policy.
  5. Policy Type: Identify the type of policy based on the companion policy. Select from homeowner, mobilehome/manufactured home, condominium, or renters.
  6. Coverage Information: Answer all questions related to the dwelling, including construction type, number of stories, and whether the property has been inspected.
  7. Coverage Limits: Choose desired coverage limits for personal property, loss of use, and any additional options available.
  8. Premium Calculation: Calculate the premium based on the selected coverage and payment options. Indicate whether you prefer annual or installment payments.
  9. Send Bill To: Specify who should receive the bill, either the insured or the mortgagee.
  10. Additional Interests: Provide information for any additional interests, including type, name, address, and loan number if applicable.
  11. Remarks: Include any additional remarks or notes as necessary.
  12. Signature: Ensure the applicant signs the application. Include the producer’s name, address, and the date and time of completion.

Your Questions, Answered

What information do I need to provide on the California Earthquake Authority form?

You will need to fill out several key pieces of information. Start with your personal details, including your name, phone numbers, and address of the property you want to insure. If you have a co-applicant, their information is also required. Additionally, you must provide details about any existing companion policy, such as the insurer's name, policy number, and coverage limits. Be prepared to answer questions regarding the property's condition, including any prior earthquake damage and safety measures in place.

What types of coverage are available through the California Earthquake Authority?

The California Earthquake Authority offers various coverage options. You can choose coverage for the dwelling, personal property, and loss of use. Coverage limits vary, with options for personal property ranging from $5,000 to $100,000. You can also select a deductible amount for these coverages. Additional options, like Limited Building Code Upgrade coverage, can be included for extra protection. It's important to carefully review these options to select what best fits your needs.

How do I calculate the premium for my earthquake insurance?

To calculate your premium, start with the base premium and add any increased limits you may choose. You may also qualify for a hazard reduction discount, which can lower your total premium. The final amount will be the sum of these components. You can opt to pay the premium annually or in installments, depending on your preference. Make sure to review your calculations to ensure accuracy before submitting the form.

What should I do if there is unrepaired earthquake damage to my property?

If your property has unrepaired earthquake damage, you should not bind the insurance. Instead, you must explain the situation in the remarks section of the application. This is crucial because the presence of unrepaired damage can affect your coverage eligibility. It’s advisable to address any damage before applying to ensure you meet the requirements for coverage.

Common mistakes

  1. Incomplete Applicant Information: Failing to provide all necessary details about the applicant and co-applicant, such as names, phone numbers, and addresses, can lead to processing delays.

  2. Incorrect Policy Dates: Not ensuring that the effective date and expiration date match the companion policy can result in coverage issues.

  3. Missing Companion Policy Details: Omitting information about the companion policy, including the insurer's name and policy number, is a common mistake that can complicate the application.

  4. Improper Coverage Selection: Selecting the wrong type of policy or coverage limits can lead to inadequate protection. It’s important to carefully choose based on the type of property.

  5. Ignoring Prior Damage: Not disclosing any unrepaired earthquake damage can be detrimental. If there is prior damage, the application should not be bound until explained in the remarks.

  6. Neglecting Inspection Questions: Failing to answer whether the property was inspected or if it has an earthquake-resistant bracing system can lead to misunderstandings about coverage eligibility.

  7. Signature and Date Omission: Forgetting to sign the application or provide the date can halt the processing. Always ensure that the application is fully signed and dated before submission.

Documents used along the form

When applying for earthquake insurance through the California Earthquake Authority, several other forms and documents may be required to ensure comprehensive coverage. Below is a list of commonly used documents that accompany the California Earthquake Authority form. Each document plays a significant role in the insurance process, helping to clarify coverage details and ensure that all necessary information is accurately provided.

  • Homeowners Insurance Policy: This document outlines the coverage provided for the home and personal property against various risks, including fire and theft. It serves as a companion policy to the earthquake insurance application.
  • Dwelling Fire Policy: This policy covers damage to a dwelling caused by fire and other specified risks. It is often used for properties that are not owner-occupied and may be required when applying for earthquake insurance.
  • Mortgage Documents: These include the mortgage agreement and any related paperwork that verifies the loan on the property. They are essential for confirming the financial interest of the lender in the insured property.
  • Property Inspection Report: This report provides an assessment of the property’s condition, including any existing damage or risks. It may be required to determine eligibility for coverage and to assess premium rates.
  • Loss History Report: This document outlines any previous claims made on the property. Insurers use this information to evaluate risk and determine coverage terms.
  • Proof of Prior Insurance: This may include documentation that shows the applicant had previous earthquake insurance coverage. It can help in determining eligibility and premium calculations.
  • Building Code Upgrade Documentation: If the property has undergone recent upgrades to meet current building codes, documentation may be needed to verify these improvements, which could affect coverage options.
  • Additional Interest Forms: If there are additional insured parties, such as co-owners or mortgagees, these forms provide necessary details about their interests in the property.
  • Payment Authorization Form: This document authorizes the insurance company to charge the applicant’s account for premium payments. It ensures that payment options are clearly understood and agreed upon.

Each of these documents plays a crucial role in the earthquake insurance application process. Having them prepared and submitted alongside the California Earthquake Authority form can help streamline the approval process and ensure that all aspects of coverage are adequately addressed.

Similar forms

Understanding the California Earthquake Authority (CEA) form can be easier when you compare it to other similar documents. Here’s a list of seven documents that share similarities with the CEA form, along with explanations of how they relate:

  • Homeowners Insurance Application: Like the CEA form, this document gathers personal information about the applicant and the property. It assesses risks and coverage options, ensuring that homeowners have the necessary protection against various hazards, including earthquakes.
  • Renters Insurance Application: This application also collects details about the applicant and the property being rented. It provides coverage options for personal belongings and liability, similar to how the CEA form addresses property coverage and limits.
  • Condominium Insurance Application: Much like the CEA form, this document focuses on the unique aspects of insuring a condo. It requires information about the unit, shared areas, and any additional coverage needed, paralleling the CEA's focus on specific property details.
  • Mobilehome Insurance Application: This form is tailored for mobilehome owners, similar to how the CEA form addresses mobile or manufactured homes. Both documents require information about the home’s structure and coverage options, ensuring appropriate protection is in place.
  • Dwelling Fire Insurance Application: This application is designed for properties that are not owner-occupied. It shares the CEA form's focus on property details and coverage limits, ensuring that the dwelling is adequately insured against fire and other perils, including earthquakes.
  • Flood Insurance Application: While primarily focused on flood risks, this application also collects personal and property information, similar to the CEA form. Both documents aim to provide necessary coverage for specific natural disasters, highlighting the importance of comprehensive insurance.
  • Umbrella Insurance Application: This document provides additional liability coverage beyond standard policies. It requires personal information and details about existing policies, much like the CEA form. Both emphasize a thorough understanding of the applicant’s insurance needs and risks.

By recognizing these similarities, you can better appreciate the importance of the CEA form and how it fits into the broader context of insurance documentation. Each of these forms plays a crucial role in protecting individuals and properties from various risks, including the significant threat of earthquakes in California.

Dos and Don'ts

When filling out the California Earthquake Authority form, there are important guidelines to follow. Here’s a helpful list of what to do and what to avoid:

  • Do provide accurate information for all applicant details, including names and contact numbers.
  • Do ensure the effective date and expiration date are the same as those of the companion policy.
  • Do complete all sections related to the type of policy you are applying for.
  • Do clearly indicate any prior earthquake damage and provide explanations in the remarks section if necessary.
  • Do calculate the premium accurately and select your preferred payment option.
  • Don't leave any required fields blank; incomplete applications can lead to delays.
  • Don't bind the policy if there is unrepaired prior earthquake damage; this could result in complications later.

By following these guidelines, you can help ensure that your application process goes smoothly. Make sure to double-check your information before submitting the form.

Misconceptions

  • Misconception 1: The California Earthquake Authority (CEA) form is only for homeowners.
  • This is incorrect. The CEA form is applicable to various types of properties, including mobile homes, condominiums, and rental units. It accommodates different policy types, ensuring that all property owners can apply for earthquake insurance.

  • Misconception 2: Filling out the form guarantees insurance coverage.
  • Completing the form does not automatically secure coverage. The application must be reviewed and approved by the insurance provider. Factors such as property condition and prior damage can affect eligibility.

  • Misconception 3: Prior earthquake damage is not a concern when applying.
  • This is false. If there is any unrepaired earthquake damage, it must be disclosed on the application. Failure to do so can lead to denial of coverage or claims in the future.

  • Misconception 4: The CEA form is the same as other insurance applications.
  • The CEA form has specific requirements and questions tailored to earthquake insurance. It differs from standard homeowner insurance applications and requires additional details about the property’s seismic safety features.

  • Misconception 5: You can choose any deductible amount without restrictions.
  • This is misleading. The CEA form offers specific deductible options based on the type of coverage selected. Understanding these limits is essential for making an informed decision about the policy.

Key takeaways

Here are some key takeaways for filling out and using the California Earthquake Authority form:

  • Complete Applicant Information: Fill in all requested details, including names, phone numbers, and addresses for both the applicant and co-applicant, if applicable.
  • Companion Policy Details: Provide information about your companion policy, including the insurer's name, policy number, and expiration date.
  • Property Information: Include the physical address of the insured property and any relevant details about its construction and condition.
  • Coverage Selection: Choose the type of policy that fits your needs, such as Homeowner, Mobilehome, or Renters, and specify coverage limits.
  • Inspection Status: Indicate whether the property has been inspected and if there is any unrepaired earthquake damage.
  • Deductible Options: Select your desired deductible for Coverage A and any other relevant coverages.
  • Premium Calculation: Calculate the total premium by adding base premium, increased limits, and any discounts.
  • Payment Options: Decide whether to pay the premium annually or in installments.
  • Additional Interests: If applicable, fill out information for any mortgagees or additional insured parties, including their names and addresses.
  • Signature Required: Ensure the applicant signs the form and includes the date and time of completion.

By following these steps, you can ensure that your application is complete and accurate, helping to facilitate the process of obtaining earthquake insurance.