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Insurance Policy - 5541 S Peoria St, Chicago, IL 60621.pdf

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Tue Feb 01 16:51:51 CST 2022 Shelter Mutual Insurance Company 1817 W Broadway Columbia, MO 65218 1-800-SHELTER (743-5837) Dwelling Insurance Policy Evidence Of Insurance As Of 02/01/2022 Policy Number: Effective Date: Expiration Date: Named Insured: LOFTY HOLDING 5541 S PEORIA STREET LLC 11718 FOLKSTONE LN LOS ANGELES, CA 90077-1310 Agent: 12-73-10784513-55 02/01/2022 (12:10 PM CST) 02/01/2023 (12:01 AM CST) LUKE ROTH 34-AB19-85 2245 W DUBLIN GRANVI WORTHINGTON, OH 43085-3336 (614) 832-7949 Poli

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Tue Feb 01 16:51:51 CST 2022
Shelter Mutual Insurance Company
1817 W Broadway
Columbia, MO 65218
1-800-SHELTER (743-5837)

Dwelling Insurance Policy
Evidence Of Insurance
As Of 02/01/2022
Policy Number:
Effective Date:
Expiration Date:

Named Insured:
LOFTY HOLDING 5541 S PEORIA
STREET LLC
11718 FOLKSTONE LN
LOS ANGELES, CA 90077-1310

Agent:

12-73-10784513-55
02/01/2022 (12:10 PM CST)
02/01/2023 (12:01 AM CST)
LUKE ROTH
34-AB19-85
2245 W DUBLIN GRANVI
WORTHINGTON, OH 43085-3336
(614) 832-7949

Policy Deductible
$1,000
Described Premises
5541 S PEORIA ST CHICAGO, IL 60621

Description
MASONRY VENEER, NON-OWNER, 2 FAMILY
DWELLING, W/ MINE SUBSIDENCE

Coverages

Limits

Dwelling
Addition of the Peril of Vandalism
Mine Subsidence Coverage Endorsement
Loss of Rents
Additional Living Expense
Drainage System Endorsement

Endorsement
Number

$250,000

$908.00
B-847.2-B
B-313.17-B

$25,000
$25,000
$10,000

B-102.7-B

Total for Term (This is Not a Bill):
Policy forms and additional endorsements attached to this policy
Loss of Rents
Additional Living Expense
Landlords Liability Coverage and Medical Payments Coverage
1000
Policy Term: 12 months
Zone Code: 001

Premium

$1,110.00

Number
RENTLOSS
ADDEXP
B-454.15-B

Protection Class: 1

Secretary

President and CEO
End of Evidence Of Insurance

B-750.1-B

Page 1 of 1

Tue Feb 01 16:51:51 CST 2022

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 5541 S PEORIA STREET LLC

1,110.00

Card Number

Transaction Number

Agent Number

Date Payment Received

************2132

2079

34-AB19-85

02/01/2022

Authorization Code
EAA7D4

Transaction Payment Type
MasterCard

Credit

Transaction Type

Card Transaction ID Number

Purchase

15862701

Risk Description

Payment Amount

Payment Detail
Policy Number
12-73-10784513-55

Insured Name
NB

LOFTY HOLDING 5541 S PEORIA STREET LLC

5541 S PEORIA 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

1,110.00

1,110.00