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State Farm Rental Dwelling Declarations - 2023-11-29 to 2024-11-29 - Policy 98-G5-4612-0 - 88 Madison Ave.pdf

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State Farm Fire and Casualty Company A Stock Company With Home Offices in Bloomington, Illinois Named Insured H-28-3AB8-FBFC Policy Period 98-G5-4612-0 Effective Date Expiration Date 12 Months NOV 29 2023 NOV 29 2024 The policy period begins and ends at 12:01 am standard time at the residence premises. R F CO, EARL VANZE Q & COOLWOOD LLC 385 S CHEROKEE ST # N216 DENVER CO 80223-2120 ____ DECLARATIONS PAGE Policy Number Po Box 2356 Bloomington IL 61702-2356 Loan # 0579768659 Mortgagee ____ ____ S

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State Farm Fire and Casualty Company

A Stock Company With Home Offices in Bloomington, Illinois

Named Insured

H-28-3AB8-FBFC

Policy Period

98-G5-4612-0
Effective Date Expiration Date

12 Months
NOV 29 2023
NOV 29 2024
The policy period begins and ends at 12:01 am
standard time at the residence premises.

R F

CO, EARL VANZE Q & COOLWOOD
LLC
385 S CHEROKEE ST # N216
DENVER CO 80223-2120

____

DECLARATIONS PAGE
Policy Number

Po Box 2356
Bloomington IL 61702-2356

Loan # 0579768659
Mortgagee

____
____

SHELLPOINT MORTGAGE SERVICING
ISAOA ATIMA
PO BOX 7050
TROY MI 48007-7050

____
____

____

____

RENTAL DWELLING POLICY- SPECIAL FORM 3

Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subject to the

28

IPPD

premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the
Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law.
Location of Premises
88 MADISON AVE
ALBANY NY 12202-2034

DEC 19 2023

Named Insured: Limited Liability Company
Zone 17 Protection Class 10 Construction Masonry

Coverages & Property

Limits of Liability Inflation Coverage Index: 376.7
Deductibles - Section I

Section I
A Dwelling
Dwelling Extension
B Personal Property
C Loss of Rents

$
$
$

400,000
40,000
20,000
Actual Loss

Section II
L Business Liability
(Each Occurrence)
Annual Aggregate
M Medical Payments
(Each Person)

$
$

500,000
1,000,000

$

5,000

Forms, Options, & Endorsements
Special Form 3
Amendatory Endorsement
Rental Dwelling Endorsement
Terrorism Insurance Cov Notice
Modified Replacement Cost
Losses Not Insured Amendatory
Debris Removal Endorsement
Notice in Event of Liab Claim
Lead Poisoning Exclusion
Mandatory Reportng Endorsement
Real Property Endorsement
Arson Reward Delete

FP-8103.3
FE-8232.2
FE-5610
FE-6999.3
FE-7466.2
FE-8777
FE-7540
FE-1319
FE-8499
FE-5801
FE-5401
FE-5307

Basic

1%

Policy Premium

$

4,000

$

1,659.00

Other limits and exclusions may apply - refer to your policy

Your policy consists of this page, any endorsements
and the policy form. Please keep these together.
FP-8006.3C
20

0523 1 51 I
N 1S,G,Q1,J

RYAN STACEY
Prepared

DEC 19 2023

802-862-0865

555-7020.1 Rev. 10-2002 (o1f039fc)

CONTINUED FROM FRONT SIDE

BK

o1f0396g
Rev. 09-2005