The California Earthquake Authority form is an essential application for individuals seeking earthquake insurance in California. This form gathers vital information about the applicant, their property, and existing insurance policies to ensure adequate coverage against potential earthquake damage. If you’re ready to protect your home and belongings, fill out the form by clicking the button below.
The California Earthquake Authority (CEA) form serves as a crucial tool for homeowners seeking earthquake insurance in California. This application collects essential information about the applicant and the property to ensure that coverage is tailored to specific needs. Applicants will provide their personal details, including names and contact numbers, as well as the physical and mailing addresses of the insured property. The form also requires information about any companion insurance policies, such as the participating insurer's name and policy number, which must align with the CEA policy's expiration date. Coverage options are detailed, allowing applicants to select limits for dwelling coverage, personal property, and loss of use. Additionally, the form addresses vital safety features of the property, such as whether it has been inspected for earthquake damage or if it is secured to its foundation. Applicants can also choose payment options and specify who should receive the insurance bill. Finally, the form concludes with a section for remarks and requires the applicant's signature, ensuring that all provided information is accurate and complete.
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)
Street Address of Physical Location of I nsured Property
Mailing Address (if different)
Number and Street Address
Unit
City
State
ZI P Code
County
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
CondominiumRenters
Rating Territory
Year Built
Number of Stories,
I ncluding Basement
Construction Type
Frame
Other
Number of Chimneys
Square Footage
Foundation Type
Raised
Slab
Roof Type
Composition
Tile
Wood Shake
Property I nspected?
Yes
No
Date
I s there unrepaired prior
earthquake damage to
the dwelling?
I f yes, DO NOT BI ND and explain in Remarks
Dwelling secured to
foundation?
Cripple walls braced with
plywood or equivalent?
Water heater secured to
building frame?
Dwelling — Coverage A
Dwelling Limit
$
Mobile or Manufactured
Is the home reinforced by
an earthquake resistant
bracing system certified by
the California Department
of Housing and Community
Development?
I f yes, attach a copy of the certification
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
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
There is a $750 deductible for this coverage
«AND »
Option Three
Loss Assessment — Coverage E
$3,750 deductible
Only available if value of property is $135,000 or less
$7,500 deductible
$11,250 deductible
Remarks
Additional Limited Building Code Upgrade
— optional —
I ncrease Limited Building Code Upgrade coverage from $10,000 to a total limit of $20,000
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
Loss Payee
2nd Mortgagee
Additional I nsured Address
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
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.
Filling out the California Earthquake Authority form is an important step in securing your earthquake insurance. After completing the form, it will be submitted for processing. Make sure all information is accurate to avoid delays.
What is the purpose of the California Earthquake Authority form?
The California Earthquake Authority (CEA) form is used to apply for earthquake insurance. This insurance helps protect homeowners, renters, and property owners in California from financial losses due to earthquake damage. Completing this form accurately is crucial to ensure coverage for your property.
Who needs to fill out this form?
Any individual or entity seeking earthquake insurance in California must complete this form. This includes homeowners, renters, and owners of mobile homes or condominiums. If there is a co-applicant, they must also provide their information on the form.
What information is required on the form?
The form requires personal information such as the applicant's name, contact numbers, and the address of the property to be insured. Additionally, details about any companion insurance policies, property characteristics, coverage limits, and deductibles must be provided. Accurate information ensures that the application is processed smoothly.
What types of properties can be insured?
The form accommodates various property types, including single-family homes, mobile homes, condominiums, and rental properties. Each type has specific requirements and coverage options that must be selected based on the property’s characteristics and existing insurance policies.
What are the coverage options available?
Coverage options include dwelling coverage, personal property coverage, and loss of use coverage. Applicants can choose different limits for each type of coverage based on their needs. Optional upgrades, such as increased building code upgrade coverage, may also be available.
How is the premium calculated?
The premium is calculated based on several factors, including the property type, coverage limits selected, and any discounts for hazard reduction measures. The form includes a section for calculating the total premium, which can be paid annually or in installments.
What should I do if there is prior earthquake damage?
If there is unrepaired earthquake damage to the dwelling, the applicant must indicate this on the form. It is important to note that if there is prior damage, the application cannot be bound until the issue is resolved, and further explanation should be provided in the remarks section.
What is the significance of the applicant's signature?
The applicant's signature on the form confirms that the information provided is accurate and that the applicant is applying for the indicated insurance. This signature is essential for processing the application and may also be required for any future claims.
Filling out the California Earthquake Authority (CEA) form can be a daunting task, especially when the stakes are high. One common mistake people make is failing to provide accurate contact information. It’s essential to list both the applicant's and co-applicant's telephone numbers correctly. If the insurance company cannot reach you, it may delay the processing of your application or even lead to a denial of coverage. Double-checking this information can save you from unnecessary headaches later.
Another frequent error involves the companion policy information. Applicants often overlook the requirement to match the expiration date of the CEA policy with that of the companion policy. This mismatch can lead to complications during the claims process. If the dates do not align, the insurance coverage may be deemed invalid. Therefore, it is crucial to confirm that all dates are consistent before submitting the form.
Additionally, many applicants neglect to answer all questions regarding the property. For instance, the form asks whether the property has been inspected and if there is any unrepaired earthquake damage. Omitting these details can result in a denial of coverage. Insurers rely on this information to assess risk accurately, and failing to disclose it could jeopardize your policy. Always provide complete and honest answers to ensure that your application is processed smoothly.
Finally, applicants sometimes forget to sign the form. The signature serves as a confirmation that the information provided is correct and that the applicant understands the terms of the insurance policy. Without a signature, the application is incomplete and cannot be processed. To avoid this oversight, make it a habit to review the entire form before submission, ensuring that all required fields, including the signature, are filled out.
The California Earthquake Authority (CEA) form is an important document for individuals seeking earthquake insurance. Along with this form, several other documents and forms are commonly used to ensure comprehensive coverage and compliance with insurance requirements. Below is a list of these documents, each described briefly to provide clarity on their purpose.
Understanding these documents can help individuals navigate the insurance process more effectively. Each plays a vital role in ensuring adequate coverage and protection against potential losses due to earthquakes and other risks.
Homeowners Insurance Application: Similar to the California Earthquake Authority form, this document collects personal information, property details, and insurance coverage options. It serves to assess risk and determine premium rates based on the applicant's home and belongings.
Flood Insurance Application: Like the earthquake application, this form gathers essential applicant information and property specifics. It focuses on flood risk assessment and coverage limits, ensuring that homeowners are protected against water damage.
Auto Insurance Application: This document requests details about the applicant, vehicle information, and coverage preferences. It assesses risk factors such as driving history and vehicle type, similar to how the earthquake form evaluates property risk.
Renters Insurance Application: This form is akin to the earthquake application in that it collects information about the applicant and their personal property. It focuses on protecting renters' belongings against various risks, including theft and damage.
Condominium Insurance Application: Similar to the California Earthquake Authority form, this application gathers details specific to condo ownership, including shared property coverage. It assesses unique risks associated with condominium living.
Mobile Home Insurance Application: This document parallels the earthquake form by collecting information specific to mobile home ownership. It evaluates risk factors and coverage options tailored to mobile homes.
Landlord Insurance Application: Like the earthquake application, this form focuses on properties rented out to tenants. It gathers information about the property and the coverage needed to protect against tenant-related risks.
Commercial Property Insurance Application: This document shares similarities with the earthquake form by assessing business property risks. It collects detailed information about the business location and the types of coverage needed.
Liability Insurance Application: This application is comparable to the earthquake form in that it gathers personal and property details to assess liability risks. It determines the necessary coverage to protect against potential claims.
Umbrella Insurance Application: Similar to the earthquake application, this form collects personal information and existing coverage details. It evaluates the need for additional liability protection beyond standard policies.
When filling out the California Earthquake Authority form, it's essential to be careful and thorough. Here are five things you should and shouldn't do:
Following these guidelines can help ensure a smoother application process and avoid potential issues down the line.
Ensure all applicant information is complete. This includes names, telephone numbers, and addresses for both the applicant and any co-applicants. Incomplete information can delay the processing of your application.
Check the companion policy details carefully. The expiration date of the California Earthquake Authority (CEA) policy must match the expiration date of the companion policy. This is crucial for maintaining coverage.
Understand the different policy types. The CEA policy type depends on the companion policy you hold, such as homeowner, mobilehome, or renter’s insurance. Selecting the correct type ensures appropriate coverage.
Accurately calculate your premium. Include base premiums, any increased limits, and available discounts. This will help you understand the total cost and payment options available, whether annual or in installments.
Provide any necessary remarks. If there are issues such as unrepaired earthquake damage, it is vital to note these on the application. Transparency is key to avoiding complications with your policy.