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BEACH PLAN

ALTERNATIVE PROCEDURES TO EXPEDITE PROCESSING APPLICATIONS

ON DWELLING AND CERTAIN COMMERCIAL PROPERTIES.

(This Supplemental Application – Producer’ s Inspection Report is also required for Windstorm and Hail Only polices

written in either the Beach or Seacoast areas)

TO:

North Carolina Insurance Underwriting Association

Date: _____/_____/_____

PO Box 8009

Cary, NC 27512

NCIUA File No.:____________________

(If known)

1. Name of Applicant:___________________________________________________________________________

2. Location of Property:__________________________________________________________________________

_____________________________NC

Zip Code:_______________

County:________________________

(Note: If located within boundaries of approved Rural Fire District, show above)

3. Construction:_____ Frame_____ Other (show type) Roof:_____ Approved_____ Unapproved______

Approx.Year of Construction:________ Approx.Total Area (all floors):______ (Commercial)-Enclosed Area______

(Habitational) Living Area:_____ Porches:_____ Attached Decks:_____

Is building located within 150’ of normal high tide? Yes_____ No_____

4. Occupancy (Show each type of occupant in building):___________________________________________________

______________________________________________________________________________________________

5. Endorsements Applicable:_________________________________________________________________________

______________________________________________________________________________________________

ITEMS 6 & 7 MUST BE ANSWERED IF FIRE INSURANCE IS DESIRED (see Item 10 on back)

6. Rating classification:

A. Dwelling or Commercial Protection Class at property location __________

(Note: Some municipalities have split Protection Classes, which the proper class depends upon distance from hydrant and fire department

response time. The correct Protection Class is required.)

B. Commercial: Fire Class Rate CSP Code:_____ or Risk ID#:______

C. Seasonal:______Yes _______No

7. Other Structures (See reverse Item 9 for definition) show insurable value:

Walkways (including steps to beach): $_______ Garage:$______ Gazebo:$______

Deck (separate from Dwelling):$_____ Other (specify):____________________________________________ $________

Many “Other Structures” are not covered for windstorm and hail damage unless specifically listed on the Policy Declarations

page. Refer to the DP-3232 (Peril 2.b.) for specific details regarding structures not covered for windstorm and hail. To buy back

windstorm and hail coverage on these other structures, they must be listed: ___________________________________________

________________________________________________________________________________________________________

8. I hereby certify that the above indicated building is located in the “Beach Area” of North Carolina as defined in General

Statute 58-45-5 (See Item 2 on reverse). Or, if for Windstorm and Hail Only coverage the indicated building is located in either

the Beach, or Seacoast Territories of North Carolina.

Date of Inspection: _____/_____/_____

______________________________________________________

(Signature of Producer)

ATTACH RECENT ORIGINAL

PHOTOGRAPH HERE

(FRONT ANGLE)

IMPORTANT: SEE INSTRUCTIONS ON REVERSE SIDE

BP-16 (02/00)

Form Bp-16 - Beach Plan Alternative Procedures To Expedite Processing Applications On Dwelling And Certain Commercial Properties - North Carolina Insurance Underwriting Association

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