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Shelter Dwelling Insurance Evidence - 2022-02-22 - Policy 12-73-10784513-69 - 7542 & 7656 S Colfax Ave - 7542 and 7656 S Colfax Ave, Chicago, IL 60649.pdf

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Tue Feb 22 16:06:51 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 02/22/2022 Policy Number: Effective Date: Expiration Date: Named Insured: LOFTY HOLDING 7542 AND 7656 S COLFAX AVENUE LLC 11718 FOLKSTONE LN LOS ANGELES, CA 90077-1310 Agent: 12-73-10784513-69 02/21/2022 (3:58 PM CST) 02/21/2023 (12:01 AM CST) LUKE ROTH 34-AB19-85 2245 W DUBLIN GRANVI WORTHINGTON, OH 43085-3336 (614) 832-7

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Tue Feb 22 16:06:51 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 02/22/2022
Policy Number:
Effective Date:
Expiration Date:

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

Agent:

12-73-10784513-69
02/21/2022 (3:58 PM CST)
02/21/2023 (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
7656 S COLFAX AVE CHICAGO, IL 60649

Description
MASONRY VENEER, NON-OWNER, 3 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

$402,800

$2,239.00
B-847.2-B
B-313.17-B

$40,280
$40,280
$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
1000000/1000
Policy Term: 12 months
Zone Code: 001

Premium

$2,499.00

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 22 16:06:51 CST 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
7656 S COLFAX AVENUE LLC, LOFTY HOLDING 7542 AND / 7656 S COLFAX AVENUE LLC,
LOFTY HOLDING 7542 AND
Type
Number
Amount
Transaction Number
Agent Number
Card

MC *3478

$2,499.00

2150

Payment Amount
2,499.00
Date Payment Received

34-AB19-85

02/22/2022

Risk Description

Payment Amount

Payment Detail
Policy Number
12-73-10784513-69

Insured Name
NB

LOFTY HOLDING 7542 AND 7656 S COLFAX
AVENUE LLC

7656 S COLFAX 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

2,499.00

2,499.00