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Wed Jan 26 12:47:19 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 01/26/2022 Policy Number: Effective Date: Expiration Date: Named Insured: LOFTY HOLDING 8143 S SANGAMON STREET LLC 11718 FOLKSTONE LN LOS ANGELES, CA 90077-1310 Agent: 12-73-10784513-49 01/26/2022 (1:05 PM CST) 01/26/2023 (12:01 AM CST) LUKE ROTH 34-AB19-85 2245 W DUBLIN GRANVI WORTHINGTON, OH 43085-3336 (614) 832-7949 Pol

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Wed Jan 26 12:47:19 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 01/26/2022
Policy Number:
Effective Date:
Expiration Date:

Named Insured:
LOFTY HOLDING 8143 S SANGAMON
STREET LLC
11718 FOLKSTONE LN
LOS ANGELES, CA 90077-1310

Agent:

12-73-10784513-49
01/26/2022 (1:05 PM CST)
01/26/2023 (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
8143 S SANGAMON ST CHICAGO, IL 60620

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

Coverages

Limits

Dwelling
Masonry Veneer, W/ Mine Subsidence
Addition of the Peril of Vandalism
Mine Subsidence Coverage Endorsement
Loss of Rents
Additional Living Expense
Drainage System Endorsement

Endorsement
Number

$300,000
$15,000

$1,088.00
$66.00
B-847.2-B
B-313.17-B

$30,000
$30,000
$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

$1,392.00

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

Wed Jan 26 12:47:19 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 8143 S SANGAMON STREET LLC

1,392.00

Card Number

Transaction Number

Agent Number

Date Payment Received

************6946

2052

34-AB19-85

01/26/2022

Authorization Code
136328

Transaction Payment Type
MasterCard

Credit

Transaction Type

Card Transaction ID Number

Purchase

15820703

Risk Description

Payment Amount

Payment Detail
Policy Number
12-73-10784513-49

Insured Name
NB

LOFTY HOLDING 8143 S SANGAMON STREET
LLC

8143 S SANGAMON 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

1,392.00

1,392.00