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Fri Sep 23 15:12:33 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 09/23/2022 Policy Number: Effective Date: Expiration Date: Named Insured: LOFTY HOLDING 3850 W 17TH STREET LLC 66 W FLAGLER ST 900 MIAMI, FL 33130-1807 Agent: 34-73-10784513-106 09/23/2022 (3:07 PM CST) 09/23/2023 (12:01 AM CST) LUKE ROTH 34-AB19-85 2245 W DUBLIN GRANVI WORTHINGTON, OH 43085-3336 (614) 832-7949 Policy Dedu

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Fri Sep 23 15:12:33 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 09/23/2022
Policy Number:
Effective Date:
Expiration Date:

Named Insured:
LOFTY HOLDING 3850 W 17TH
STREET LLC
66 W FLAGLER ST 900
MIAMI, FL 33130-1807

Agent:

34-73-10784513-106
09/23/2022 (3:07 PM CST)
09/23/2023 (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
3850 W 17TH ST CLEVELAND, OH 44109

Description
FRAME, NON-OWNER, 2 FAMILY DWELLING

Coverages

Limits

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

Endorsement
Number

$311,000
$31,100
$10,000

Premium
$1,125.00

B-102.7-B
B-451.5-B

$31,100
$1,215.00

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

Number
ADDEXP
B-454.12-B
RENTLOSS

ADDITIONAL INSURED
DTS PROPERTY MANAGEMENT
29115 ANDERSON RD
WICKLIFFE, OH 44092-2357
Policy Term: 12 months
Zone Code: 002

Protection Class: 1

Secretary

President and CEO
End of Evidence Of Insurance

B-750.1-B

Page 1 of 1

Fri Sep 23 15:12:33 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

W 17TH STREET LLC, LOFTY HOLDING 3850 / W 17TH STREET LLC, LOFTY HOLDING 3850

1,215.00

Type

Number

Amount

Transaction Number

Agent Number

Date Payment Received

Card

MC *5011

$1,215.00

2806

34-AB19-85

09/23/2022

Risk Description

Payment Amount

Payment Detail
Policy Number
34-73-10784513-106

Insured Name
NB

LOFTY HOLDING 3850 W 17TH STREET LLC

3850 W 17TH ST

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

1,215.00

1,215.00