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Property Insurance 2023-01-24 - 1315 E 114th St Cleveland, OH 44106 - 1315 E 114th St, Cleveland, OH 44106.pdf

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EVIDENCE OF INSURANCE ISSUE DATE: 04/26/2023 THIS EVIDENCE OF INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. AGENCY Obie Insurance Services 167 N Green St Suit

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EVIDENCE OF INSURANCE
ISSUE DATE: 04/26/2023

THIS EVIDENCE OF INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE
ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICY BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A
CONTRACT BETWEEN THE ISSUING INSURER, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL
INTEREST.
AGENCY
Obie Insurance Services
167 N Green St
Suite 1360
Chicago, IL 60607

COMPANY
Great American
c/o OSC
3550 George Busbee Pkwy NW, Suite 300
Kennesaw, GA 30144

PHONE NUMBER
773-820-7132

EMAIL
matthew@obierisk.com

INSURED
Black Cannon LFTY0300 DAO LLC
66 W Flagler St
#900
Miami, FL 33130

CERTIFICATE NUMBER
2382364

POLICY NUMBER
E927023

EFFECTIVE DATE
01/24/2023

EXPIRATION DATE
01/24/2024

PROPERTY INFORMATION
LOCATION/DESCRIPTION
1315 E 114th St
Cleveland, OH 44106

PROPERTY TYPE
Single Family Residence

THE POLICY INSURANCE LISTED BELOW HAS BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH
RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED
BY THE POLICY DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY. LIMITS
SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

COVERAGE INFORMATION
Coverage / Perils / Forms
Property Coverage
Loss of Rent
Liability

Amount of Insurance

Deductible

$203,840.00
$15,300.00
$1,000,000 occurrence / $2,000,000 aggregate

Residential: $2,500.00
Wind/Hail/Hurricane: Greater of Building ($2,500) or 3% of TIV
($6,574)

REMARKS (Including Special Conditions)

*** Please remit payment to avoid cancellation for non payment ***
Make Payments Payable To:
OSC
P.O Box 105589
Atlanta, GA 30348-5589

Replacement Cost Optional Coverage
Applies

Should you have any questions, please call Obie Insurance Services administration
offices at 773-820-7132.

Property Premium:

$920.00

Liability Premium:

$120.00

Surplus Lines Tax:

$51.38

Surplus Lines Service Fee:

$0.62

Total: $1,092.00

CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICY BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL
BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

ADDITIONAL INTEREST

AUTHORIZED REPRESENTATIVE
NAME AND ADDRESS

ObieInsuranceServicesRiskSecurePlus - 5274001