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<br />i~OV. L I. LUU 1 1L: Jj~M <br /> <br />NO~AK MU! UAL ] NS <br /> <br />... HOMEOWNERS DEClARA nONS <br />..... <br />Not/aIc Mutual InSllTllnt:e Company <br />nOl 112 A"" Nofth, P,OlQ ~ F8IgO. Non" Cbk"", 58108.250< <br />,. en - el4. [,OIl ......_""'fll'"',""'"' <br /> <br />No. 9241 <br /> <br />P. 2 <br /> <br />INSURED COpy <br /> <br /> <br />PATRICK SCHERLlNG <br />PO BOX 1982 <br />FARGO NO 58108 <br /> <br />POLICY' CHANGE <br />Change Effective: 11/06/2007 <br />I. Policy Period FrO,m: 07/02i2007 <br />To: 07/02/2008 <br />1;t01 ^!;II S-."".<d 'r,,,,. 1Il1he ~.fe;!m9Ad_. tAI..N....-..IlnoUl1ld <br /> <br />Numcd wllr.:rt: <br /> <br /> <br />Insured Phone# (1-1)701-237.3157 <br /> <br />Payment Plan: FULL-PAY <br />TOTAL ANNUAL POLICY PREMIUM: <br /> <br />$2,169.00 <br /> <br />Designated Premise -- <br />7508 CHRISANWAY <br />--"- /-------.. FARGQ..NQ..SS104-7315 /,--~...., <br />("""-J ~............... "'_________"'"'.,. ' "--'\ <br /> <br />i Additlonall1esiden<>> Premise.. Occupied by Insured.. "- <br />\~ GARDEN @ PART OF LOTS 6 AND 7, BLOCK 5, CHRIS AN SUBDIVISION, ) <br />FARGO, ND / <br />~/ "- ,.~----""""" ".../ '------------ <br />~ ~ ----- -,,/ <br />DIscounts Appliecl.... MATliRE1mM~OWNER DIScoONT.. MULTI-LINE DISCOUNT <br />SMOKE DETECTOR & FIRE EXTING. -- DEADBOL T LOCKS <br /> <br />COVERAGES AND LIMITS OF LIABILITY <br />Insurlln~ Is afforded only lor tile coverogM for which timl'" 01 Uability or prQmium charges ate indicated, <br /> <br />HO u 5 COMPREHENSIVE FORM -- ULTRA P!'1E:FERREO $500 DEDUCTIBLE wlt/'l $1.000 WIND/HAIL DEOUCTIBLE <br />YEAR 8UIL T: 1986 ROOF YEAR" 1986 Frame <br />-- SECTION 1- <br /> <br />A. DWELLING <br />B. OTHER STRUCTURES <br />C.PERSONALPROPERTY <br />D, LOSS OF USE <br />.. SECTION II .. <br />E. PERSONAL liABILITY <br />F, MEDICAL PAYMENTS TO OTHERS .. EACH PERSON <br />-. EACH ACCIDENT <br /> <br />LIMITS <br />$ 401,700 <br />$ 40.170 <br />$ 32t,360 <br />$ 200.850 <br /> <br />$ 500.000 <br />$ 5.000 <br />$ 25.000 <br /> <br />PREMIUM <br />$ 1,46300 <br />INCLUDED <br />INCLUDED <br />INCLUDEO <br /> <br />$ 25,00 <br />$ 6,00 <br /> <br />ADDITIONAL FORMS AND ENDORSEMENTS ATTACHED <br /> <br />SECTION I .. <br />FE 003 WATER BACK UP & SUMP DISCHARGE.. $1,000 DEDUCTIBLE <br />HO 0420 SPECIFIED ADOL iNS.COV A.25o/. <br />HO 0461 SCHeDULED PERSONAL PROPERTY <br />HO 04 90 PERS PROPERTY REPLACEMENT COST <br /> <br />$ 10,000 <br /> <br />$ 34,207 <br /> <br />SECTION II .. <br />HO 24 70 ADbL RESIDENCE RENTED TO OTHER <br />HO 24 82 PERSONAll NJURY <br /> <br />SECTION I AND II .. <br />HO 0427 LIMITED FUNGI, WET/DRY ROT COV <br /> <br />$ 1.000 <br /> <br />Tot1\1 Annval Policy Premium <br /> <br />$ 150,00 <br />NQ Charge <br />$ 306,00 <br />$ , BO.OO <br /> <br />$ 25,00 <br />$ 14,00 <br /> <br />No Charge <br /> <br />$ 2,16900 <br />