Placer West Insurance Services

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Homeowners' Insurance

To receive your free insurance quote, please fill out the request form below. To see how we use your personal information, please see our Privacy Policy.

Contact Information
*Your Name:
Your Spouse's Name:
*Home Address:
*City (California Only):
Address Information

Full Address Of The Home To Be Insured:

Your Current Full Address (if different):

Full Prior Address (if you have moved within 3 years):

Current Insurance
Claims (Within 5 years)
Date: Amount: Type:
Dog Information
Type History of Biting? Explanation (if applicable)
Pool Information


Diving Board?



Requested Coverage (if unsure, enter current coverage)
Dwelling: Medical:
Liability: Deductable:
Other Structure: Personal Property:
Jewelry: Other:
Protective Devices
Smoke Alarm:
Burglar Alarm:
Replacement Cost Information (required)
*Year Built: *Sq. Ft.:
*House Style: *Roof Type:
*Number of Full Bathrooms: *Number of Half Bathrooms:
*Foundation Type And Percentage (All Percentages Must Total To 100%)
Slab Percent
Crawl Space Percent
Pier Percent
Basement Percent
*Ext. Walls Type *HV/AC
*Garage *Porch Type *Sq. Ft.
*Number of Fireplaces *Deck Type *Sq. Ft.
*Fireplace Type

Federal Poverty Level (FPL) Chart

View Chart

HSA Contribution Limits

Please be aware of the 2016 annual HSA contribution limits listed below.

  • $3,350* - Maximum HSA Annual Contribution Limit (Self-only)
  • $6,650* - Maximum HSA Annual Contribution Limit (Family)
  • $1,000 - HSA Catch-up Contribution Limit
  • $1,300 - Minimum HDHP Annual Deductible (Self-only)
  • $2,600 - Minimum HDHP Annual Deductible (Family)
  • $6,450 - Maximum HDHP Annual Out-of-pocket (Self-only)
  • $12,900 - Maximum HDHP Annual Out-of-pocket (Family)
  • *For purposes of the full contribution rule an employee is treated as being eligible for the entire calendar year as long as he or she is eligible as of December 1 of that calendar year and continues eligibility throughout the following year. However, failure to maintain eligibility during the "testing period" will result in adverse tax consequences (including an additional excise tax). The testing period begins in December of the year in which the employee becomes eligible and ends the last day of December of the following year.

Words of Wisdom

“I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them.”
– Thomas Jefferson

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