Laserfiche WebLink
<br />DECLARATIONS <br />NORTH DAKOTA HOMEOWNERS POLICY. GOLD STAR SPECIAL DELUXE FORM (ED 06194) NO <br />NON-ASSESSABLE POLICY ISSUED BY AMERICAN FAMILY MUTUAL INSURANCE COMPANY <br />A MEMBER OF THE AMERICAN FAMILY INSURANCE GROUP, MADISON. WI <br />PLEASE READ YOUR POLICY <br /> <br />POLICY NUMBER 33DC-0137-01 <br /> <br />MORTGAGEE <br />REFERENCE NUMBER: 0028217701 <br />WELLS FARGO BANK NA #708 <br />ITS SUCCESSORS AND/OR ASSIGNS <br />PO BOX 5708 <br />SPRINGFIELD, OH 45501-'708 <br /> <br />NAMED INSURED <br />HARR, DBRRICK & KRISTA <br />611 HILLSIDE DR <br />FARGO, ND S8104~8104 <br />COVERAGES AND LIMITS PROVIDED <br />001 FAMILY FRAME DWELLING IN TOWN CLASS 3 <br /> <br />EFFECTIVE <br />FROM 10/16/2007 TO 1011612008 <br />ACCT 012-073-971-62 <br /> <br />SECTION I <br />DWELLING <br />PERSONAL PROPERTY ON PREMISES <br />PERSONAL PROPBRTY OFF PREMISES 100% SUBJECT TO POLICY LIMITATION <br />LOSS OF USE - ACTUAL LOSS SUSTAINED WITHIN 12 MONTHS OF mE LOSS $500 (1 000 W. d/H'"1 <br />DEDUCTIBLE AMOUNT. ALL PERIL . 10 al <br />SECTION II <br />PERSONAL LIABILITY <br />MEDICAL EXPENSE <br />ADDmONAL PROTECTION I ENDORSEMENTS <br />OPTION 2. EXTENDED COVERAGE ON JEWELRY, WATCHES AND FURS <br />OPTION 14 - PERSONAL PROPERTY REPLACEMENT COVERAGE <br />PLEASURE HORSE & EQUIPMENT COV (END 406 ED 6/94) - %NUMBBROFHOURSES HORSES <br />NORTH DAKOTA AMENDATORY HOMEOWNERS (END 584A (NO) ED 10/06) <br />ENVIRONMENTALlPERSONAL POLLUTION DAMAGE COV (END 523 ED 9/94) <br />FUNGI OR BACI'ERIA EXCLUSION (END 595 ED 6/02) <br />GOLD STAR HOMEOWNERS AMENDATORY (END 587 ED 10199) <br /> <br />LIMITS <br />$221,100 <br />$165,900 <br /> <br />$1,000,000 <br />$S,Ooo <br /> <br />THlS POLlCY INCLUDES INCREASED BUlLOING LIMIT COVERAGB UP TO 120% OF THE <br />DWELLING LIMIT SHOWN ABOVE. SUBJECT TO POLICY PROVISIONS. <br />CLAIM FREE DISCOUNT HAS BEEN APPLIED <br />HOME & AUTO DISCOUNT HAS BEEN APPLIED <br /> <br />TOTAL PREMIUM <br /> <br />$1,456.00 <br /> <br />LATEST BUILDING COST INDEX IS 176 <br /> <br />Declarations effective on the date shown above. These declarations form a part of this policy and replace all other <br />declarations which may have been issued previously for this policy. If these declarations are accompanied by a new <br />policy, the policy replaces any which may have been issued before with the same policy number. <br /> <br />AUTHORIZED ~.. .1. S'~ <br />REPRESENT AliVE \f"";resident <br /> <br />~~[.Jf~ <br />U 5ectill~ry <br /> <br />AGENT 286-386 PHONE (701) 293-0798 <br /> <br />Chris Heise Agency, Inc. <br />4553 9th Ave S Ste 3 <br />Fargo,ND 58103-7239 <br /> <br />Fonn No. H().47C <br /> <br />1of2 <br /> <br />Stook No. 23281 <br />