Insurance - 2025-11-29 - 88 Madison Ave, Albany, NY 12202.pdf

Page 1

State Farm Fire and Casualty Company

PO Box 2356
Bloomington IL 61702-2356

AT1 H-28-3AB8-FBFC R F
000584 0001
HERON LFTY0314 DAO LLC
30 N GOULD ST STE R
SHERIDAN WY 82801-6317

RENEWAL CERTIFICATE

POLICY NUMBER 98-G5-4612-0

Rental Dwelling Pol - Special Form
NOV 29 2024 to NOV 29 2025

PAID BY SPECIFIED PARTY

Coverages and Limits

Section I
A. Dwelling $411,200
Dwelling Extension 41,120
B. Personal Property 20,560
C. Loss of Rents Actual Loss

Deductibles - Section I
Basic 2.00% 8,224

Section II
L. Business Liab (per occurrence) $500,000
(annual aggregate) 1,000,000
M. Medical Payments to Others 5,000
(each person)

Annual Premium $1,528.00

Forms, Options, and Endorsements
Special Form 3 FP-8103.3
Amendatory Endorsement FE-8232.2
Debris Removal Endorsement FE-7540
Lead Poisoning Exclusion FE-8499
Arson Reward Delete FE-5307
Real Property Endorsement FE-5401
Modified Replacement Cost FE-7466.2
Notice in Event of Liab Claim FE-1319
Mandatory Reportng Endorsement FE-5801
Losses Not Insured Amendatory FE-8777
Rental Dwelling Endorsement FE-5610
Terrorism Insurance Cov Notice FE-6999.3

Continued on back of page

Subzone: 10 Zone: 17 Construction: Masonry

Please help us update the data used to determine your premium. Contact your agent with the year each of your home's utilities (heating/cooling, plumbing, or electrical) and roof were last updated.

## Page 2

NOTICE TO POLICYHOLDER:

For a comprehensive description of coverages and forms, please refer to your policy.

Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy.

Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date.

If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent.

Please keep this with your policy.
Forms, Options, and Endorsements
Additional Insured

OPT AI