Cert of Ins 08162016.pdfStjjterjjjmyn State Farm Fire and Casualty Company
PO Box 5000
Dupont, WA 98327-5000
AT1 H-15- 2697--FB3C H W F
008650 0001
CITY OF EDMONDS,
ENGINEERING DIVISION
ENROACHMENT PERMIT #E-05-008
121 5TH AVE N BLD6 DIVISION
EDMONDS WA 98020-3145
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Insured: HECK, DOLIGLASA&PAM-LAA
Location: 338 8TH AVE S RECEIVE
EDMONDS WA 98020-3412 .,JUL 0 5 2016
ENGINES"JI NG DIVIc
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 DwIg Up to $115,720 OPT ID
Ordinance/Law 10%/ $57,860 OPT Ol..
Earthquake Excl Masonry Veneer FE -7572.4
Amendatory Endorsement FE -2368
Jewelry and Furs $1,500/$2,500 OPT JF
RENEWAL CERTIFICATE
Homeowners ijoiicy
AUG 16 2016 to AUG 16 2017
PAID BY SPECIFIED PARTY
Coverages and Limits
Section I
A Dwelling $578,600
Dwelling Extension Up To 57,860
B Personal Property 433 950
C Loss of Use Actual Loss
Sustained
Deductibles - Section I
Other Losses 1/2% 2,893
Except 10% Earthquake
L Personal Liability $500,000
Damage to Property of Others 500
M Medical Payments to Others 5,000
(Each Person)
Annual Premium
Earthquake Premium
Premium Reductions
Home/Auto Discount
Claim Record Discount
$2,173.00
1,128.00 (Included)
Inflation Coverage Index: 252.7
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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CO
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38-1.00
322,00
Moving? See your State Fann agent.
�N I E L S'or "We"W See reverse for irnportant information.
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N 19583 901 Al Ag
014 Telephone (425) 640-3091
Mortgagee: WELLS FAR8OBANK NA#938
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Add Ins -II: CITY OF EDMONDS,
301