Ethan Frome
640524535179000Email Address: claimsteam@goldeneagle-124587013271500Producer Name:109220013271500Submitted By:124587012446000Phone and Email:109220012446000Phone and Email:Named InsuredName and Address:9525105410002476526606500Contact Name:66675011811000Phone #:58928011811000E-mail:Coverage66675010731500Policy #:109220015113000Certificate #:96583511747500Bank Loan #:109220013843000Inception Date:109220012827000Expiration Date:Check One of Each Category:1) Dwelling ? or Building ? 3)Lender Placed ? Real Estate Owned ? Investor ? 2) Vacant ? or Occupied ? 4)Notice of Insurance attached: Yes ? No ?Check Policy TypeHazard ? Flood Only ? Wind Only ? Other ?Coverage AmountsDwellingOther structuresPersonal PropertyLoss of UseDeductiblesOther – please describeSubject to Forms(insert form numbers,Edition dates, special Deductibles)Named Insured Interest: Owner ? Property Manager ? Receiver/Trustee ? Other ?140843014732000Mortgagee(s) Name:? No Mortgagee(s) (please check if none exists on loss location)196469013843000Additional Insured(s) Name:? No Additional Insured(s) (please check if none exists on loss location)Loss103060512065000Facts of Loss:103060510922000Date of Loss:122174016002000Date of Discovery:148209015621000Damage Description:160464512382500Damages Reported By:109220012382500Date Reported:148209014160500Phone # and E-mail:258127513716000Police or Fire Dept to which reported: Contact Information (whom to contact for loss description and access)140843012890500Name/Relationship:66675012446000Phone #:50292012446000E-mail:Other InsuranceCarrier Name:Prior ?Current ?Effective Dates of Coverage: From ToPolicy Number:Agent Name:Phone #:440309012700000168338512700000Form was completed by: Date:Submit all information via email to claimsteam@ ................
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