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Insurance - 2024-02-22 - 5541 S Peoria St, Chicago, IL 60621.pdf

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FOUNDERS INSURANCE COMPANY SM Homeowners A MULTIPLE LINE STOCK COMPANY 1350 E. Touhy Avenue, Suite 200W, DESPLAINES, IL 60018 (847)768-0040 / Fax (847)795-0080 New Business Declaration EFFECTIVE AGENCY ACCT 02/22/24 Binder Date: 02/21/24 01:22 PM POLICY NUMBER FROM POLICY PERIOD 2/22/24 REIL112001 TO 2/22/25 2383 12 : 01 AM STANDARD TIME NAMED INSURED AND ADDRESS PRODUCER INSURANCE NAVY BROKERS, INC. 10338 S HARLEM AVENUE PALOS HILLS IL 60465 708-237-0404 5541 S PEORIA ST , 1 CHICAGO IL 60621 70

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FOUNDERS INSURANCE COMPANY SM

Homeowners

A MULTIPLE LINE STOCK COMPANY
1350 E. Touhy Avenue, Suite 200W, DESPLAINES, IL 60018
(847)768-0040 / Fax (847)795-0080

New Business Declaration

EFFECTIVE

AGENCY ACCT

02/22/24

Binder Date: 02/21/24 01:22 PM

POLICY NUMBER

FROM

POLICY PERIOD

2/22/24

REIL112001

TO

2/22/25

2383

12 : 01 AM STANDARD TIME

NAMED INSURED AND ADDRESS

PRODUCER

INSURANCE NAVY BROKERS, INC.
10338 S HARLEM AVENUE
PALOS HILLS IL 60465
708-237-0404

5541 S PEORIA ST , 1
CHICAGO IL 60621
708-475-5339

BASIC
COVERAGES
PREMIUM

ATTACHED
ENDORSEMENTS
PREMIUM

$183.00

$125.00

SCHEDULED
PROPERTY
PREMIUM

POLICY
FEES/TAXES

TOTAL
POLICY
PREMIUM

ADDITIONAL/
RETURN
PREMIUM

$308.00

$0.00

LOCATION 001
PROP DEDUCT

FORM

CONST

$500.00

04

MA

YEAR

PROGRAM

UNITS

OCCUP

PROT CLASS

TERR

01

4

2

COVERAGE LIMITS AND PREMIUM - SECTION I
Coverage -C- (Personal Property)

$10,000.00

Coverage-D- (Additional Living Expense)

$2,000.00

$161.00

COVERAGE LIMITS AND PREMIUM - SECTION II
Coverage - E- (Personal Liability)

$100,000.00

Coverage - F- (Medical Liability)

$2,000.00

$22.00

LOCATION (S) OF PROPERTY INSURED
INSURED PROPERTY IS LOCATED AT THE ABOVE ADDRESS

POLICY FORMS AND ENDORSEMENTS
NUMBER

DATE

LOC

ILHO4SP

12 18

Special Provisions - Illinois

1

ILHOME4J

09 16

Policy Jacket

1

HOME4

03 16

Contents Broard Form

1

HO4-HSD

03 16

Other Named Household Resident
CYNTHIA WASHUP

1

ITEM

1

LIMIT

PREMIUM

$25.00

FOUNDERS INSURANCE COMPANY SM

Homeowners

A MULTIPLE LINE STOCK COMPANY
1350 E. Touhy Avenue, Suite 200W, DESPLAINES, IL 60018
(847)768-0040 / Fax (847)795-0080

New Business Declaration

EFFECTIVE

AGENCY ACCT

Binder Date: 02/21/24 01:22 PM

POLICY NUMBER

FROM

POLICY PERIOD

2/22/24

REIL112001

TO

2/22/25

12 : 01 AM STANDARD TIME

NAMED INSURED AND ADDRESS

09 16

2383

PRODUCER

INSURANCE NAVY BROKERS, INC.
10338 S HARLEM AVENUE
PALOS HILLS IL 60465
708-237-0404

5541 S PEORIA ST , 1
CHICAGO IL 60621
708-475-5339
HO 04 95

02/22/24

Water Back-Up and Sump Discharge or
Overflow

1

$100.00

THIS REPLACES ALL PREVIOUSLY ISSUED POLICY DECLARATIONS, IF ANY. THIS POLICY APPLIES ONLY TO ACCIDENTS, OCCURRENCES,
OR LOSSES WHICH HAPPEN DURING THE POLICY PERIOD SHOWN ABOVE.

Insured

WWW.FOUNDERSINSURANCE.COM

2/21/24