Effective Date of Coverage

Submissions are to be emailed to the Plan Administrator. A copy of the deposit check MUST be included in the emailed submission. The $250 deposit check is to be made out to HPIA and mailed to HPIA 745 Fort Street Mall Suite 1100, Honolulu, HI 96813. Coverage is effective the LATER of the complete submission receipt date OR the date the deposit check is received in the Plan Administrator’s office.

A complete submission consists of:

• Completed Acord Application (include TMK) – Signed and dated by Applicant and Agent
• Replacement Cost Estimator (RCE) – version HPIA 1006 0922 – Signed and dated by Applicant and Agent
• New Business Supplemental Information and Checklist – Signed and dated by Applicant and Agent
• Supplemental Information and Checklist – Signed and Dated by Applicant and Agent
• Two (2) Current Clear and Bright Color Photos (front and rear of dwelling)
• One (1) Current Clear and Bright Color Photo of water catchment tank (if applicable)
• Homeowners/Dwelling Fire Supplemental Questionnaire (ONLY required for dwellings more than 30 yrs of age) – Signed and dated by Applicant and Agent
• Signed Acknowledgment of Hurricane, Flood and Earthquake Coverage Exclusion – Signed and dated by Applicant and Agent
• Indicate Premium (Quote) – Generated from the ICE Comparative Rating System or provided by Plan Administrator
• Copy of Deposit Check ($250 deposit or payment in full is required)
• Declinations by two (2) insurance companies (provide insurance company names)
• OPUS
• County Tax Record or MLS