ENG20130143.pdf��t��rttd�rdurrr` State Farm Fire and Casualty Company y �J RENEWAL CERTIFICATE
PO Box 5000
t-tlt)(Wt, A 98327--5000 ii V 1 f �l� l _.._._. ..
fi o' Vo
ATI H-15- 2969-FB3C H W F
008316 0001
CITY OF EDMONDS
C/O BLDG DIVISION
PERMIT SPECIALIST
ST USE RENEWAL PERMIT#85-3
121 5TH AVE N
EDMONDS WA 98020-3145
0
RECEIVED
�s
FEB I It 2017
Insured: CLYBORNE, RONALD A & 'l/ NEE; I " J)j ( m„
MICHELLE C
Location: 9325 OLYMPIC VIEW DR
EDMONDS WA 98020-2397
Loss Settlement Provisions (See Policy)
Al Replacement Cost - Similar Construction
131 Limited Replacement Cost - Coverage B
Forms, Options, and Endorsements
Homeowners Policy
FP -7955 . WA
Jewelry and Furs $2,5001$5,000
Silverware Theft $10,000
OPT JF
OPT SG
Firearms $2,500/$5,000
OPT FA
Earthquake, Excl Masonry Veneer
FE -7572.4
Back -Up Dwell/Listed Property
FE -5432.1
Increase Dwlg up to $154,880
OPT ID
Orftance/Law 10%/ $77,440
OPT OL
Additional Insured
OPT AI
Identity Restoration Coverage
FE -3301
Amendatory Endorsement
FE -2368
t-*cneowners l'ol'rr,y
MAR o 2017 o MAR 29 2018
PAID BY SPECIFIED PARTY
Coverages and Limits mm
Section I
A Dwelling
Dwelling Extension Up To
B Personal Property
C Loss of Use
Deductibles - Section I
Other Losses 1.00%
Except 20% Earthquake
Section 11
L Personal Liability
Damage to Proporty of Others
M Medical Payments to Others
(Each Person)
Annual Premium
Earthquake Premium
Sewer & Drain
Premium Reductions
Home Alert Discount
Home/Auto Discount
Claim Record Discount
Inflation Coverage Index
932.00
22.00
265.6
Please help
update the data used to
urilCon'tact
with
h the year each of
your hometilities(heatig/coolg plumbing, or electa) and roof were last updated.
$774,400
77,440
630,100
Actual Loss
Sustained
7,744
$100,000
500
5,000
$2,030.00
(Included)
(Included)
107.00
457.00
380.00
" �41 � u,S'S� ve c. � t il�9eaving ? See your. trttc,w /:.arra agent.
N 2asa rin A t Dt1LIN ICI ANC�AtENY INC See reverse Or important trtferrrrartrcan.
Ag REB Prepared FEB 07 2017
Telephone (425) 742-9304