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Wed Oct 05 10:37:06 CDT 2022 Shelter Mutual Insurance Company 1817 W Broadway Columbia, MO 65218 1-800-SHELTER (743-5837) Dwelling Insurance Policy Evidence Of Insurance As Of 10/05/2022 Policy Number: Effective Date: Expiration Date: Named Insured: YELLOWSTONE LFTY0160 LLC 66 W FLAGLER ST 900 MIAMI, FL 33130-1807 Agent: 34-73-10784513-117 10/01/2022 (9:08 AM CST) 10/01/2023 (12:01 AM CST) LUKE ROTH 34-AB19-85 2245 W DUBLIN GRANVI WORTHINGTON, OH 43085-3336 (614) 832-7949 Policy Deductible $2,50

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Wed Oct 05 10:37:06 CDT 2022
Shelter Mutual Insurance Company
1817 W Broadway
Columbia, MO 65218
1-800-SHELTER (743-5837)

Dwelling Insurance Policy
Evidence Of Insurance
As Of 10/05/2022
Policy Number:
Effective Date:
Expiration Date:

Named Insured:
YELLOWSTONE LFTY0160 LLC
66 W FLAGLER ST 900
MIAMI, FL 33130-1807

Agent:

34-73-10784513-117
10/01/2022 (9:08 AM CST)
10/01/2023 (12:01 AM CST)
LUKE ROTH
34-AB19-85
2245 W DUBLIN GRANVI
WORTHINGTON, OH 43085-3336
(614) 832-7949

Policy Deductible
$2,500
Described Premises
13806 COIT RD CLEVELAND, OH 44110

Description
FRAME, NON-OWNER, 1 FAMILY DWELLING

Coverages

Limits

Dwelling
Additional Living Expense
Addition of Broad Perils-Addition of Restoration Cost Cov
Drainage System Endorsement ($28.00)
Loss of Rents

Endorsement
Number

$353,000
$35,300

$1,270.00
B-451.5-B
B-102.7-B

$10,000
$35,300

$1,360.00

Total for Term (This is Not a Bill):
Policy forms and additional endorsements attached to this policy
Additional Living Expense
Landlord Liability Coverage and Medical Payments Coverage
1000000/1000
Loss of Rents
ADDITIONAL INSURED
DTS PROPERTY MANAGEMENT
29115 ANDERSON RD
WICKLIFFE, OH 44092-2357
Policy Term: 12 months
Zone Code: 002

Premium

Number
ADDEXP
B-454.12-B
RENTLOSS

ADDITIONAL INSURED
LOFTY AI INC
66 W FLAGLER ST 900
MIAMI, FL 33130-1807
Protection Class: 1

Secretary

President and CEO
End of Evidence Of Insurance

B-750.1-B

Page 1 of 1

Wed Oct 05 10:37:06 CDT 2022

SHELTER INSURANCE COMPANIES
1817 WEST BROADWAY, COLUMBIA, MISSOURI 65218-0001
ShelterInsurance.com
Phone:1-800-SHELTER
Federal Tax ID: 43-0613000
Payor Name / Cardholder

Payment Amount

LFTY0160 LLC, YELLOWSTONE / LFTY0160 LLC, YELLOWSTONE

1,360.00

Type

Number

Amount

Transaction Number

Agent Number

Date Payment Received

Card

MC *6863

$1,360.00

2851

34-AB19-85

10/05/2022

Risk Description

Payment Amount

Payment Detail
Policy Number
34-73-10784513-117

Insured Name
NB

YELLOWSTONE LFTY0160 LLC

13806 COIT RD

Total Payment Received:
For policy details or payment questions, please contact your agent or call 1-800-SHELTER (1-800-743-5837).

M-1408.2-M

Receipt

1,360.00

1,360.00