1026 EDMONDS ST-CERT OF INS.pdf�rat� State Farm Fire and Casualty Company
PO Box 5000
Dupont, WA 98327-5000
AT 1 H-15- 2508-FB3C H W F
006047 0001
CITY OF EDMONDS
121 5TH AVE N
EDMONDS WA 98020-3145
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JAN 0 5 2017
Insured: MEAD, T LINDSAY & KIMBERLEE CINE13iNG (DIVISION
Location: 1026 EDMONDS ST
EDMONDS WA 98020-2905
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
Increase Dwlg up to $115,060
OPT ID
Ordinance/Law 100/o/ $57,530
OPT OL
Earthquake Excl Masonry Veneer
FE-7572.4
Amendatory Endorsement
FE-2368
Jewelry and Furs $1,500/$2,500
OPT JF
RENEWAL CERTIFICATE
POLICY NUMBER 47 BJ I`7�a 1 3
Homeowners Policy
FEB 08 2017 to FEB 08 2018
PAID BY SPECIFIED PARTY
Coverages and Limits
Section I
A Dwelling $575, 300
Dwelling Extension Up To 57,530
B Personal Property 431 475
C Loss of Use Actual Loss
Sustained
Deductibles - Section I
Other Losses 1/2% 2,876
Except 20% Earthquake
Section II
L Personal Liability $300, 000
Damage to Property of Others 500
M Medical Payments to Others 3,000
(Each Person)
Annual Premium
Earthquake Premium
Premium Reductions
Home Alert Discount
Home/Auto Discount
Claim Record Discount
$1,555.00
673.00 (Included)
Inflation Coverage Index: 260.4
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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SCANNED
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JAA 12 2017
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0
87.00
374.00
311.00
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Farm agent.
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N 1187s 901 Al Ag t PETER OLIVEY REP Prepared DEC 20 2016
314 Telephone (425) 776-0133