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<br />SAFECO INSURANCE COMPANY OF AMERICA
<br />Home Office: 4333 Brooklyn Ave. N.E., Seattle, Washington 98185 (A stock insurance company.)
<br />QUALITY-PLUS HOMEOWNERS POLICY DECLARATIONS
<br />
<br />INSURED:
<br />WILLIAM WEBSTER
<br />7314 CHRISAN BLVD
<br />FARGO ND 58104-7306
<br />
<br />POLICY NUMBER: OZ3617 56 3
<br />POLICY PERIOD FROM: OCT. 22 2008
<br />AT: 12:01 A.M.
<br />TO: OCT. 22 2009
<br />
<br />RESIDENCE PREMISES:
<br />Same
<br />
<br />AGENT:
<br />JOHNSON & JOHNSON INS AGY LLC
<br />PO BOX 158
<br />MOORHEAD MN 56561-0000
<br />
<br />TELEPHONE: 1-866-472-3326
<br />
<br />t.lHPOltTANT,:'::NOT:ICES((:(:'(/::)::';::'),'::'::\:/,/!:,::)\:::,(\.,::::,H:,::f,::/,::.:::;::::,:::::::H:}:}/,::.:;:::::':{,{:\}::\?,:;:::::::)}::::::{,::{ff,:;:::,:;:,:;::::/U::::::':;:::'::i
<br />
<br />- Your policy has changed effective September 23, 2008.
<br />
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<br />
<br />SECTION I - PROPERTY COVERAGES
<br />A - Dwelling
<br />B - Other Structures
<br />C - Personal Property
<br />D - Loss of Use
<br />
<br />$ 253,100 $
<br /> 25,310
<br /> 189,830
<br /> 12 MONTHS
<br /> 500,000
<br /> 2,000
<br /> 63, 275
<br /> 25,310
<br />
<br />1,031.00
<br />
<br />SECTION II - lIABILITY COVERAGES
<br />E - Personal Liability (each occurrence)
<br />F - Medical Payments (each person)
<br />
<br />32.00
<br />
<br />INCLUDED COVERAGES
<br />Full Value on Personal Property
<br />Extended Dwelling Coverage-25% of Cov A Limit
<br />Building Ordinance or Law Coverage
<br />
<br />Included
<br />Included
<br />Included
<br />
<br />I....'................::.:............................... ............................
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<br />$ 11,765 $
<br />5,000
<br />
<br />PREMIUM) .i;::1
<br />82.00
<br />65.00
<br />82.00
<br />
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<br />. . . . . . . . . . . . - - - . . - . . . . - .
<br />............--..... ...
<br />
<br />Option E - Scheduled Personal Property
<br />Option YY - Water Back-up and Sump Overflow
<br />Option KK - Special Personal Property
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<br />........... .......... ...................
<br />
<br />Renewal Credit
<br />
<br />$
<br />
<br />15%
<br />
<br />-155.00
<br />
<br />I' DED............ .1..........
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<br />. . n ~.~ .......AMOUNt::::......
<br />N/A $ 500
<br />N/A 1,000
<br />
<br />Section I, except as noted below
<br />Windstorm or Hail Deductible
<br />
<br />t........... :fQfACANNijALPREHIUM...::~. ..$<:>ta3't~ocf >1
<br />
<br />You can pay your premium in full or in installments. If you pay in installments, a
<br />$4.00 service charge will apply to each installment. If you pay by automatic
<br />deduction, no service charge will apply.
<br />
<br />CHO-6000/EP 9/06
<br />
<br />CONTINUED
<br />Page 1 of 2
<br />
<br />ORIGINAL
<br />DATE PREPARED SEPT 23 2008
<br />
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