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Insurance Policy - 4318 Clybourne Ave Cleveland, OH 44109.pdf

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Tue Sep 21 15:34:45 CDT 2021 Shelter Mutual Insurance Company 1817 W Broadway Columbia, MO 65218 1-800-SHELTER (743-5837) Dwelling Insurance Policy Evidence Of Insurance As Of 09/21/2021 Named Insured: LOFTY HOLDING 4318 CLYBOURNE AVENUE LLC 11718 FOLKSTONE LN LOS ANGELES, CA 90077-1310 Policy Number: Effective Date: Expiration Date: Agent: 34-73-10784513-7 09/21/2021 (3:43 PM CST) 09/21/2022 (12:01 AM CST) LUKE ROTH 34-AB19-85 2245 W DUBLIN GRANVILLE RD WORTHINGTON, OH 43085-3336 (614) 832-7949

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Tue Sep 21 15:34:45 CDT 2021
Shelter Mutual Insurance Company
1817 W Broadway
Columbia, MO 65218
1-800-SHELTER (743-5837)

Dwelling Insurance Policy
Evidence Of Insurance
As Of 09/21/2021
Named Insured:
LOFTY HOLDING 4318 CLYBOURNE AVENUE LLC
11718 FOLKSTONE LN
LOS ANGELES, CA 90077-1310

Policy Number:
Effective Date:
Expiration Date:
Agent:

34-73-10784513-7
09/21/2021 (3:43 PM CST)
09/21/2022 (12:01 AM CST)
LUKE ROTH
34-AB19-85
2245 W DUBLIN GRANVILLE RD
WORTHINGTON, OH 43085-3336
(614) 832-7949

Policy Deductible
$500
Described Premises
4318 CLYBOURNE AVE CLEVELAND, OH 44109

Description
FRAME, NON-OWNER, 2 FAMILY DWELLING

Coverages

Limits

Dwelling
Additional Living Expense
Drainage System Endorsement ($66.00)
Addition of the Peril of Vandalism
Loss of Rents

Endorsement
Number

$225,000
$22,500
$15,000

$1,162.00
B-102.7-B
B-847.2-B

$22,500
$1,266.00

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
1000
Loss of Rents
Policy Term: 12 months
Zone Code: 002

Premium

Number
ADDEXP
B-454.12-B
RENTLOSS

Protection Class: 2

Secretary

President and CEO
End of Evidence Of Insurance

B-750.1-B

Page 1 of 1

Tue Sep 21 15:34:45 CDT 2021

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

Payment Amount

LOFTY HOLDING 4318 CLYBOURNE AVENUE LLC

1,266.00

Card Number

Transaction Number

Agent Number

Date Payment Received

************9278

1681

34-AB19-85

09/21/2021

Authorization Code
60C3E6

Transaction Payment Type
MasterCard

Credit

Transaction Type

Card Transaction ID Number

Purchase

15019159

Risk Description

Payment Amount

Payment Detail
Policy Number
34-73-10784513-7

Insured Name
NB

LOFTY HOLDING 4318 CLYBOURNE AVENUE
LLC

4318 CLYBOURNE AVE

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

1,266.00

1,266.00