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Insurance Policy - 8708 Willard Avenue, Cleveland, OH 44102.pdf

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Tue Jan 18 17:43:13 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 01/18/2022 Policy Number: Effective Date: Expiration Date: Named Insured: LOFTY HOLDING 8708 WILLARD AVENUE LLC 11718 FOLKSTONE LN LOS ANGELES, CA 90077-1310 Agent: 34-73-10784513-43 01/18/2022 (3:42 PM CST) 01/18/2023 (12:01 AM CST) LUKE ROTH 34-AB19-85 2245 W DUBLIN GRANVI WORTHINGTON, OH 43085-3336 (614) 832-7949 Policy

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Tue Jan 18 17:43:13 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 01/18/2022
Policy Number:
Effective Date:
Expiration Date:

Named Insured:
LOFTY HOLDING 8708 WILLARD
AVENUE LLC
11718 FOLKSTONE LN
LOS ANGELES, CA 90077-1310

Agent:

34-73-10784513-43
01/18/2022 (3:42 PM CST)
01/18/2023 (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
8708 WILLARD AVE CLEVELAND, OH 44102

Description
FRAME, NON-OWNER, 1 FAMILY DWELLING

Coverages

Limits

Dwelling
Additional Living Expense
Drainage System Endorsement ($33.00)
Addition of the Peril of Vandalism
Loss of Rents

Endorsement
Number

$150,000
$15,000
$10,000

$581.00
B-102.7-B
B-847.2-B

$15,000
$671.00

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: 1

Secretary

President and CEO
End of Evidence Of Insurance

B-750.1-B

Page 1 of 1

Tue Jan 18 17:43:13 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 8708 WILLARD AVENUE LLC

671.00

Card Number

Transaction Number

Agent Number

Date Payment Received

************4072

2029

34-AB19-85

01/18/2022

Authorization Code
81D0C4

Transaction Payment Type
MasterCard

Credit

Transaction Type

Card Transaction ID Number

Purchase

15771273

Risk Description

Payment Amount

Payment Detail
Policy Number
34-73-10784513-43

Insured Name
NB

LOFTY HOLDING 8708 WILLARD AVENUE LLC 8708 WILLARD 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

671.00

671.00