ENG20130145.pdfi�^f�fraprrr State Farm Fire and Casualty Company
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006055 0001
CITY OF EDMONDS
BUILDING DIVISION
121 5TH AVE N FL 2
EDMONDS WA 98020-3145
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RECEIVED
(s
FEB 17 2017
Insured: WELLER, ERIC F & PAULA B ENGINEERING DIVISION
Location: 19925 88TH AVE W
EDMONDS WA 98026-6309
Loss Settlement Provisions (See Policy)
Al Replacement Coot - Similar ConStrt4ction
131 Limited leplacewnerut Cost - (acve�°age B
Forms, Options, and Endorsements
Homeowners Policy
FP-7955.WA
Earthquake Excl Masonry Veneer
FE -7572.4
Increase Dwlg up to $82,880
OPT ID
Ordinance/Law 10%/ $41,440
OPT OL
Jewelry and Furs $2,500/$5,000
OPT JF
Firearms $2,500/$:;,000
OPT FA
Amendatory Endorsement
FE -2368
RENEWAL CERTIFICATE
MAR 31 2017 to MAR 31 2018
PAID BY SPECIFIED PARTY
Coverages and Limits
Section I
A Dwelling
Dwelling Extension Up To
B Personal Property
C Loss of Use
Deductibles - Section I
Other Losses 1/2%
Except 10% Earthquake
Section II
L Personal Liability
Damage to Property of Others
M Medical Payments to Others
(Each Person)
$414,400
41,440
310 800
Actual Loss
Sustained
2,072
$500,000
500
5,000
Annual Premium $2,101.00
Earthquake Premium 808.00 (Included)
Premium Reductions
Claim Record Discount 280.00
Inflation Coverage Index: 265.6
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.
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`� BILL WA6VTON INKS G NCY INC REe ee rev'drse t Proparodt FEBn09 20117
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