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Insurance Policy - 7542 & 7656 S Colfax Ave, Chicago, IL 60649 - 7542 and 7656 S Colfax Ave, Chicago, IL 60649.pdf

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12-73- -010784513-0070 12-73-10784513-70 AB19 D O I Y INSERT DEC Shelter Mutual Insurance Company 1817 W Broadway Columbia, MO 65218 1-800-SHELTER (743-5837) D 00I050168220 ZwyQSXT ZYrBBnK x60QODT juCC11c lpLvpvp Dwelling Insurance Policy Declarations Named Insured: LOFTY HOLDING 7542 AND 7656 S COLFAX AVENUE LLC 11718 FOLKSTONE LN LOS ANGELES CA 90077-1310 Policy Number: Effective Date: Expiration Date: 12-73-10784513-70 02-21-2022 (11:40 AM CST) 02-21-2023 (12:01 AM CST) Agent: LUKE ROTH 34-0A

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12-73- -010784513-0070

12-73-10784513-70

AB19

D

O

I

Y

INSERT

DEC

Shelter Mutual Insurance Company
1817 W Broadway
Columbia, MO 65218
1-800-SHELTER (743-5837)

D
00I050168220

ZwyQSXT
ZYrBBnK
x60QODT
juCC11c
lpLvpvp

Dwelling Insurance Policy Declarations
Named Insured:
LOFTY HOLDING 7542 AND 7656 S COLFAX AVENUE LLC
11718 FOLKSTONE LN
LOS ANGELES CA 90077-1310

Policy Number:
Effective Date:
Expiration Date:

12-73-10784513-70
02-21-2022 (11:40 AM CST)
02-21-2023 (12:01 AM CST)

Agent:

LUKE ROTH
34-0AB19-85
2245 W DUBLIN GRANVI
STE 107A
WORTHINGTON OH 43085
614-832-7949

Policy Deductible
$1,000
Described Premises
7542 S COLFAX AVE IN CHICAGO IL 60649 (COUNTY 0031)

Description
MASONRY VENEER, NON-OWNER, 3 FAMILY
DWELLING, W/ MINE SUBSIDENCE

Coverages

Limits

DWELLING
Mine Subsidence Coverage Endorsement
See Endorsement
Addition of the Peril of Vandalism
Drainage System Endorsement
Landlords Liability Coverage and Medical Payments Coverage
$1000- Medical Limit

Endorsement
Number

$405,000

$10,000
$1,000,000

B-313.17-B

$2,253.00
$129.00

B-847.2-B
B-102.7-B
B-454.15-B

$47.00
$70.00

Total for Term (This is Not a Bill):

$2,499.00

Policy forms and additional endorsements attached to this policy

Number

Dwelling Insurance Policy - Basic Coverage Form
Amendatory Endorsement-Illinois
Exclusion-Electronic Smoking Device
Exclusion-Cannabis

B-450.3-B
B-187.1-B
B-311.1-B
B-310.16-B

(For Office Use Only)
Transaction: N.B.
H. O. CODE: 2,499.00
Policy ID: 63007800136
Policy Term: One Year
County: 31

Premium

Tier: 1000
Protection Class: 01
Date Issued: 02-23-2022
Zone Code: 1

B-127.16-B
End of Declarations

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