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Evidence of Insurance - 2021-11-17 - 15555 Millard Ave, Markham, IL 60428.pdf
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| Property | 15555 Millard Ave, Markham, IL 60428 |
|---|---|
| Folder | (root) |
| Kind | |
| Updated | 2026-05-30 |
| Dropbox path | Evidence of Insurance - 2021-11-17 - 15555 Millard Ave, Markham, IL 60428.pdf |
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Wed Nov 17 15:29:08 CST 2021 Shelter Mutual Insurance Company 1817 W Broadway Columbia, MO 65218 1-800-SHELTER (743-5837) Dwelling Insurance Policy Evidence Of Insurance As Of 11/17/2021 Policy Number: Effective Date: Expiration Date: Named Insured: LOFTY HOLDING 15555 MILLARD AVENUE LLC 11718 FOLKSTONE LN LOS ANGELES, CA 90077-1310 Agent: 12-73-10784513-38 11/17/2021 (3:16 PM CST) 11/17/2022 (12:01 AM CST) LUKE ROTH 34-AB19-85 2245 W DUBLIN GRANVILLE RD WORTHINGTON, OH 43085-3336 (614) 832-7949 Policy Deductible $1,000 Described Premises 15555 MILLARD AVE MARKHAM, IL 60428 Description FRAME, NON-OWNER, 1 FAMILY DWELLING, W/ MINE SUBSIDENCE Coverages Limits Dwelling Frame, W/ Mine Subsidence Addition of the Peril of Vandalism Mine Subsidence Coverage Endorsement Loss of Rents Additional Living Expense Drainage System Endorsement Endorsement Number $137,500 $10,000 $621.00 $42.00…
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Wed Nov 17 15:29:08 CST 2021 Shelter Mutual Insurance Company 1817 W Broadway Columbia, MO 65218 1-800-SHELTER (743-5837) Dwelling Insurance Policy Evidence Of Insurance As Of 11/17/2021 Policy Number: Effective Date: Expiration Date: Named Insured: LOFTY HOLDING 15555 MILLARD AVENUE LLC 11718 FOLKSTONE LN LOS ANGELES, CA 90077-1310 Agent: 12-73-10784513-38 11/17/2021 (3:16 PM CST) 11/17/2022 (12:01 AM CST) LUKE ROTH 34-AB19-85 2245 W DUBLIN GRANVILLE RD WORTHINGTON, OH 43085-3336 (614) 832-7949 Policy Deductible $1,000 Described Premises 15555 MILLARD AVE MARKHAM, IL 60428 Description FRAME, NON-OWNER, 1 FAMILY DWELLING, W/ MINE SUBSIDENCE Coverages Limits Dwelling Frame, W/ Mine Subsidence Addition of the Peril of Vandalism Mine Subsidence Coverage Endorsement Loss of Rents Additional Living Expense Drainage System Endorsement Endorsement Number $137,500 $10,000 $621.00 $42.00 B-847.2-B B-313.17-B $13,750 $13,750 $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 $854.00 Number RENTLOSS ADDEXP B-454.15-B Protection Class: 5 Secretary President and CEO End of Evidence Of Insurance B-750.1-B Page 1 of 1 Wed Nov 17 15:29:08 CST 2021 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 15555 MILLARD AVENUE LLC 854.00 Card Number Transaction Number Agent Number Date Payment Received ************1165 1859 34-AB19-85 11/17/2021 Authorization Code 13AFBC Transaction Payment Type MasterCard Credit Transaction Type Card Transaction ID Number Purchase 15398489 Risk Description Payment Amount Payment Detail Policy Number 12-73-10784513-38 Insured Name NB LOFTY HOLDING 15555 MILLARD AVENUE LLC 15555 MILLARD 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 854.00 854.00