← 6914 Polonia Ave, Cleveland, OH 44105 · All properties

Insurance Policy - 6914 Polonia Ave, Cleveland, OH 44105.pdf

This page is a searchable text preview. Use the Dropbox link for the full original file.

Open full file in Dropbox

What This File Appears To Be

Tue Oct 12 13:18:33 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 10/12/2021 Policy Number: Effective Date: Expiration Date: Named Insured: LOFTY HOLDING 6914 POLONIA AVENUE LLC 11718 FOLKSTONE LN LOS ANGELES, CA 90077-1310 Agent: 34-73-10784513-20 10/11/2021 (1:02 PM CST) 10/11/2022 (12:01 AM CST) LUKE ROTH 34-AB19-85 2245 W DUBLIN GRANVILLE RD WORTHINGTON, OH 43085-3336 (614) 832-7949

Text Preview

Tue Oct 12 13:18:33 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 10/12/2021
Policy Number:
Effective Date:
Expiration Date:

Named Insured:
LOFTY HOLDING 6914 POLONIA AVENUE LLC
11718 FOLKSTONE LN
LOS ANGELES, CA 90077-1310

Agent:

34-73-10784513-20
10/11/2021 (1:02 PM CST)
10/11/2022 (12:01 AM CST)
LUKE ROTH
34-AB19-85
2245 W DUBLIN GRANVILLE RD
WORTHINGTON, OH 43085-3336
(614) 832-7949

Policy Deductible
$1,000
Described Premises
6914 POLONIA AVE CLEVELAND, OH 44105

Description
FRAME, NON-OWNER, 1 FAMILY DWELLING

Coverages

Limits

Dwelling
Frame
Additional Living Expense
Drainage System Endorsement ($50.00)
Addition of the Peril of Vandalism
Loss of Rents

Endorsement
Number

$135,000
$9,000
$13,500
$10,000

$547.00
$68.00
B-102.7-B
B-847.2-B

$13,500
$705.00

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 Oct 12 13:18:33 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 6914 POLONIA AVENUE LLC

705.00

Card Number

Transaction Number

Agent Number

Date Payment Received

************2595

1740

34-AB19-85

10/12/2021

Authorization Code
098674

Transaction Payment Type
MasterCard

Credit

Transaction Type

Card Transaction ID Number

Purchase

15162068

Risk Description

Payment Amount

Payment Detail
Policy Number
34-73-10784513-20

Insured Name
NB

LOFTY HOLDING 6914 POLONIA AVENUE LLC

6914 POLONIA 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

705.00

705.00