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Shelter Dwelling Insurance Policy 34-73-10784513-86 - 2022-05-25 to 2023-05-25 - 656 E 126th St, Cleveland, OH 44108.pdf

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Wed May 25 13:01:41 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 05/25/2022 Policy Number: Effective Date: Expiration Date: Named Insured: LOFTY HOLDING 656 E 126TH STREET LLC 66 W FLAGGER ST 100 MIAMI, FL 33130 Agent: 34-73-10784513-86 05/25/2022 (2:33 PM CST) 05/25/2023 (12:01 AM CST) LUKE ROTH 34-AB19-85 2245 W DUBLIN GRANVI WORTHINGTON, OH 43085-3336 (614) 832-7949 Policy Deductible

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Wed May 25 13:01:41 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 05/25/2022
Policy Number:
Effective Date:
Expiration Date:

Named Insured:
LOFTY HOLDING 656 E 126TH
STREET LLC
66 W FLAGGER ST 100
MIAMI, FL 33130

Agent:

34-73-10784513-86
05/25/2022 (2:33 PM CST)
05/25/2023 (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
656 E 126TH ST CLEVELAND, OH 44108

Description
FRAME, NON-OWNER, 1 FAMILY DWELLING

Coverages

Limits

Dwelling
Frame
Additional Living Expense
Drainage System Endorsement ($50.00)
Addition of Broad Perils
Loss of Rents

Endorsement
Number

$132,500
$11,000
$13,250
$10,000

Premium
$629.00
$87.00

B-102.7-B
B-544.11-B

$13,250
$806.00

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
B2B REALTY
4320 RIDGE RD
BROOKLYN, OH
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

Wed May 25 13:01:41 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

E 126TH STREET LLC, LOFTY HOLDING 656 / E 126TH STREET LLC, LOFTY HOLDING 656

806.00

Type

Number

Amount

Transaction Number

Agent Number

Date Payment Received

Card

MC *9187

$806.00

2458

34-AB19-85

05/25/2022

Risk Description

Payment Amount

Payment Detail
Policy Number
34-73-10784513-86

Insured Name
NB

LOFTY HOLDING 656 E 126TH STREET LLC

656 E 126TH 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

806.00

806.00