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Home My WebLink About102621 NEIGHBOR TO NEIGHBOR INC - INSURANCE CERTIFICATE322 05X3505250 08 000 SLG040 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 NAMED NEIGHBOR TO NEIGHBOR INC INSURED MAILING 1550 BLUE SPRUCE DR ADDRESS FT COLLINS, CO 80524-2015 POLICY PERIOD FROM 01-01-2013 TO 01-01-2014 12:01 A.M. Standard Time at your mailing address shown above. FORM OF BUSINESS CORPORATION In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as staled in this policy. SECTION I PROPERTY COVERAGE PROVIDED. BLANKET INSURANCE AT THE FOLLOWING DESCRIBED PREMISES ONLY FOR COVERAGES FOR WHICH A LIMIT OF INSURANCE IS SHOWN UNLESS COVERAGE IS PROVIDED BY AN ENDORSEMENT. DESCRIPTION OF PREMISES PREMISES NO. 0003 BUILDING NO. 001 LOCATION 1620 AZALEA ST FT COLLINS, CO 80524 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 8 CONSTRUCTION FRAME YEAR BUILT 1980 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL. 320 DESCRIPTION OF PREMISES PREMISES NO. 0004 BUILDING NO. 001 LOCATION 713 AZTEC DR FT COLLINS, CO 80521-1771 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 4 CONSTRUCTION FRAME YEAR BUILT 1982 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL. 320 AGENT 018-316 PHONE PAGE 0001 JENNIFER CLARKE 970-221-0897 BRANCH SLG040 REW 301 W MAGNOLIA ST ENTRY DATE 10-12-2012 FORT COLLINS, CO 80521-2804 BP AF 01 07 09 MEMORANDUM Stock No. 15141 Includes copyrighted material of Insurance Services Office, Inc , with its permission 322 05X3505250 08 000 SLG040 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 PREM 0027 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5, 000 PREM 0028 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5, 000 LOCATION PREMIUM BASIS RATE ADVANCE PREMIUM PREMISES NO. 0003 BUILDING NO. 001 8 UNITS $48.00 PREMISES NO. 0004 BUILDING NO. 001 4 UNITS $24.00 PREMISES NO. 0009 BUILDING NO. 001 8 UNITS $48.00 PREMISES NO. 0010 BUILDING NO. 001 8 UNITS $48.00 PREMISES NO. 0011 BUILDING NO. 001 8 UNITS $48.00 PREMISES NO. 0012 BUILDING NO. 001 8 UNITS $48.00 PREMISES NO. 0013 BUILDING NO. 001 6 UNITS $36.00 PREMISES NO. 0014 BUILDING NO. 001 6 UNITS $36.00 PREMISES NO. 0015 BUILDING NO. 001 6 UNITS $36.00 PREMISES NO. 0016. BUILDING NO. 001 6 UNITS $36.00 PREMISES NO. 0017 BUILDING NO. 001 6 UNITS $36.00 PREMISES NO. 0018 BUILDING NO. 001 6 UNITS $36.00 AGENT 018-316 PHONE PAGE 0010 JENNIFER CLARKE' 970-221-0897 BRANCH SLG040 REW 301 W MAGNOLIA ST ENTRY DATE 10-12-2012 FORT COLLINS, CO 80521-2804 BP AF 01 07 09 MEMORANDUM Stock N0. 15141 L.d...Vr.e r... e.... r.Med motn.al of Inmvonro Connroe Offiro Inr with ifc nermiccinn 322 05X3505250 08 000 SLG040 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 PREMISES NO. 0019 BUILDING NO. 001 4 UNITS $24.00 PREMISES NO. 0020 BUILDING NO. 001 4 UNITS $24.00 PREMISES NO. 0021 BUILDING NO. 001 11 UNITS $65.00 PREMISES NO. 0022 BUILDING NO. 001 3 UNITS $18.00 PREMISES NO. 0024 BUILDING NO. 001 4 UNITS $24.00 PREMISES NO. 0025 BUILDING NO. 001 4 UNITS $24.00 PREMISES NO. 0026 BUILDING NO. 001 8 UNITS $48.00 PREMISES NO. 0027 BUILDING NO. 001 8 UNITS $48.00 PREMISES NO. 0028 BUILDING NO. 001 3136 SQUARE FOOTAGE $112.00 APPLICABLE BUSINESS LIABILITY ENDORSEMENT CHARGES $148.00 TOTAL ADVANCE BUSINESS LIABILITY PREMIUM $1, 015.00 Liability forms and endorsements applying to all premises and made part of this policy at time of issue: Any endorsement followed by a state abbreviation will only apply to coverages within this state. BP 04 04 01 06 BP 04 17 07 02. BP 04 39 07 02 BP 04 48 01 06• BP 04 54 01 06 BP 04 93 01 06 BP 05 17 01 06 BP 05 77 01 06 BP 05 98 01 06 BP 10 05 07 02 BP 84,24 01 07 BP 85 04 07 10 BP 85 05 07 98CO BP 85 10 07 98 BP 85 12 01 06 IL 75 26 12 05 TOTAL ADVANCE BUSINESS PREMIUM $30, 398.00 This premium may be subject to adjustment. AGENT 018-316 PHONE PAGE 0011 JENNIFER CLARKE 970-221-0897 BRANCH SLG040 REW 301 W MAGNOLIA ST ENTRY DATE 10-12-2012 FORT COLLINS, CO 80521-2804 BP AF 01 07 09 MEMORANDUM Stock No. 15141 Includes copyrighted material of Insurance Services Office, Inc, with its permission 322 05X3505250 08 000 SLG040 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY DECLARATIONS POLICY NUMBER CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 Forms and endorsements applying to property and liability at all premises and made part of this policy at time of issue: Any endorsement followed by a state abbreviation will only apply to coverages within this state. BP IN 01 01 06 BP 00 03 01 06 BP 01 81 07 02 BP 05 01 07 02 BP 05 15 01 08 BP 05 24 01 08 BP 05 41 06 08 BP 80 01 01 07 AUTHORIZED COUNTERSIGNED REPRESENTATIVE 62L esd^� C President Secretary LICENSED RESIDENT AGENT AGENT 018-316 PHONE PAGE 0012 JENNIFER CLARKE 970-221-0897 BRANCH SLG040 REW 301 W MAGNOLIA ST ENTRY DATE 10-12-2012 FORT COLLINS, CO 80521-2804 I BP AF 01 07 09 MEMORANDUM Stock No. 15141 i....i..a.... ............ c,�„d .., s,..: �i ,.a i--.,..,. c,..,d,..... naa..., i..,. ..dot, 322 05X3505250 08 000 SLG040 AMERICAN FAMILY MUTUAL INSURANCE COMPANY M ADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 DESCRIPTION OF PREMISES PREMISES NO. 0009 BUILDING NO. 001 LOCATION 1550 BLUE SPRUCE BLDG 1 FT COLLINS CO 80524 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 8 CONSTRUCTION FRAME YEAR BUILT 1984 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0010 BUILDING NO. 001 LOCATION 1550 BLUE SPRUCE BLDG 2 FT COLLINS CO 80524 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 8 CONSTRUCTION FRAME YEAR BUILT 1984 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0011 BUILDING NO. 001 LOCATION 1550 BLUE SPRUCE BLDG 3. FT COLLINS CO 80524 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 8 CONSTRUCTION FRAME YEAR BUILT 1984 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0012 BUILDING NO. 001 LOCATION 1550 BLUE'SPRUCE BLDG 4 FT COLLINS.CO 80524 AGENT 018-316 PHONE PAGE 0002 JENNIFER CLARKE 970-221-0897 BRANCH SLG040 REW 301 W MAGNOLIA ST ENTRY DATE 10-12-2012 FORT COLLINS, CO 80521-2804 BP AF 01 07 09 MEMORANDUM Stock No. 15141 Inrludoc rnnv,inhtorl maforial of Incuranro Sen,ir2s nffire Inr with it8 nermiSSinn 322 05X3505250 08 000 SLG040 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY - POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 8 CONSTRUCTION FRAME YEAR BUILT 1984 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0013 BUILDING NO. 001 LOCATION 1550 BLUE SPRUCE BLDG 5 FT COLLINS CO 80524 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 6 CONSTRUCTION FRAME YEAR BUILT 1984 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0014 BUILDING NO. 001 LOCATION 1550 BLUE SPRUCE BLDG 6 FT COLLINS CO 80524 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 6 CONSTRUCTION FRAME YEAR BUILT 1984 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0015 BUILDING NO. 001 LOCATION 1550 BLUE SPRUCE BLDG 7 FT COLLINS CO 80524 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 6 CONSTRUCTION FRAME YEAR BUILT 1984- AGENT 018-316 PHONE PAGE 0003 JENNIFER CLARKE 970-221-0897 BRANCH SLG040 REW 301 W MAGNOLIA ST ENTRY DATE 10-12-2012 FORT COLLINS, CO 80521-2804 BP AF 01 07 09 MEMORANDUM Stock No. 15141 Includes copyrighted material of Insurance Services Office, Inc , with its permission 322 05X3505250 08 000 SLG040 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY DECLARATIONS POLICY NUMBER CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82. COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0016 BUILDING NO. 001 LOCATION 1550 BLUE SPRUCE BLDG 8 FT COLLINS CO 80524 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 6- CONSTRUCTION FRAME YEAR BUILT 1984 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0017 BUILDING NO. 001 LOCATION 1550 BLUE SPRINGS BLDG 9 FT COLLINS CO 80524 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 6 CONSTRUCTION FRAME YEAR BUILT 1984 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0018 BUILDING NO. 001 LOCATION 1550 BLUE SPRUCE BLDG 10 FT COLLINS CO 80524 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 6 CONSTRUCTION FRAME YEAR BUILT 1984 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 AGENT 018-316 JENNIFER CLARKE 301 W MAGNOLIA ST FORT COLLINS, CO BP AF 01 07 09 PHONE PAGE 0004 970-221-0897 BRANCH SLG040 REW ENTRY DATE 10-12-2012 80521-2804 MEMORANDUM Stock No. 15141 322 05X3505250 08 000 SLG040 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 DESCRIPTION OF PREMISES PREMISES NO. 0019 BUILDING NO. 001 LOCATION 613 CONIFER ST FT COLLINS, CO 80524-2149 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 4 CONSTRUCTION FRAME YEAR BUILT 1976 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0020 BUILDING NO. 001 LOCATION 619 CONIFER ST FT COLLINS, CO 80524-2150 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 4 CONSTRUCTION FRAME YEAR BUILT 1976 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0021 BUILDING NO. 001 LOCATION 533 E 4TH ST LOVELAND, CO 80537-5791 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 11 CONSTRUCTION FRAME YEAR BUILT 1965 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0022 BUILDING NO. 001 LOCATION 1051 1055 W 8TH ST LOVELAND CO 80538 AGENT 018-316 PHONE PAGE 0005 JENNIFER CLARKE 970-221-0897 BRANCH SLG040 REW 301 W MAGNOLIA ST ENTRY DATE 10-12-2012 FORT COLLINS, CO 80521-2804 BP AF 01 07 09 MEMORANDUM Stock No. 15141 Includes copyrighted material of Insurance Services Office, Inc , with its permission 322 05X3505250 08 000 SLG040 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633.82 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 3 CONSTRUCTION FRAME YEAR BUILT 1970 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0024 BUILDING NO. 001 LOCATION 2405 CRABTREE DR FT COLLINS, CO 80521-4165 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 4 CONSTRUCTION FRAME YEAR BUILT 1980 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0025 BUILDING NO. 001 LOCATION 2413 CRABTREE DR FT COLLINS, CO 80521-4121 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 4 CONSTRUCTION FRAME YEAR BUILT 1980 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0026 BUILDING NO. 001 LOCATION 2404 CLEARVIEW AVE FT COLLINS, CO 80521-4164 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 8 CONSTRUCTION JOISTED MASONRY YEAR BUILT 1960 AGENT 018-316 PHONE PAGE 0006 JENNIFER CLARKE 970-221-0897 BRANCH SLG040 REW 301 W MAGNOLIA ST ENTRY DATE 10-12-2012. FORT COLLINS, CO 80521-2804 BP AF 01 07 09 MEMORANDUM Stock No. 15141 322 05X3505250 08 000 SLG040 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY TO S POLICY NUMBER DECLARA I N CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0027 BUILDING NO. 001 LOCATION 1041 PONDEROSA DR FT COLLINS, CO 80521-4184 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY APARTMENT BUILDING WITHOUT MERCANTILE NUMBER OF UNITS 8 CONSTRUCTION JOISTED MASONRY YEAR BUILT 1967 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 DESCRIPTION OF PREMISES PREMISES NO. 0028 BUILDING NO. 001 LOCATION 1550 BLUE SPRUCE DR FORT COLLINS, CO 80524-2015 BUILDING INTEREST OWNER OCCUPIED PREDOMINANT OCCUPANCY OFFICE — NOT OTHERWISE CLASSIFIED (NOC) CONSTRUCTION FRAME YEAR BUILT 1982 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 320 PROPERTY DEDUCTIBLE $1, 000 OTHER PROPERTY DEDUCTIBLE(S) OPTIONAL COVERAGE/GLASS DEDUCTIBLE $500 SEWER BACKUP AND SUMP OVERFLOW DEDUCTIBLE $500 COVERAGE LIMIT OF INSURANCE PREMIUM BUILDING -Blanket $8,226,384 $26,687.00 REPLACEMENT COST AUXILIARY BUILDINGS/STRUCTURES - Blanket $317,600 $607.00 REPLACEMENT COST BUSINESS PERSONAL PROPERTY - Blanket $131 , 695 $533.00 REPLACEMENT COST AUTOMATIC INCREASE IN COVERAGE 4% AGENT 018-316 PHONE PAGE 0007 JENNIFER CLARKE 970-221-0897 BRANCH SLG040 REW 301 W MAGNOLIA ST ENTRY DATE 10-12-2012 FORT COLLINS, CO 80521-2804 BP AF 01 07 09 MEMORANDUM Stock No. 15141 Includes copyrighted material of Insurance Services Office, Inc , with its permission 322 05X3505250 08 000 SLG040 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 ADDITIONAL COVERAGE LIMIT OF INSURANCE PREMIUM BUSINESS INCOME ACTUAL LOSS SUSTAINED INCLUDED OTHER COVERAGES OR OPTIONS LIMIT OF INSURANCE PREMIUM WATER BACKUP AND SUMP OVERFLOW $5, 000 $1, 428.00 ORDINANCE OR LAW COVERAGE SEE BP 04 46 $123.00 Property forms and endorsements applying to this premises and made part of this policy at time of issue: Any endorsement followed by a state abbreviation will only apply to coverages within this state. BP 84 09 01 07 BP 84 11 07 98 BP 85 11 12 08 BP 12 03 01 06 BP 84 10 07 98 BP 04 46 01 06 MORTGAGEHOLDER PREMISE NO. BUILDING NO FIRST NATIONAL BANK 0009 001 ITS SUCCESSORS AND/OR ASSIGNS 205 W-OAK ST FT COLLINS, CO 80521-2712 MORTGAGEHOLDER PREMISE NO. BUILDING NO THE HOME STATE BANK 0009 001 303 E MOUNTAIN AVE 0011 001 FORT COLLINS, CO 80524-2913 0013 001 0015 001 0017 001 MORTGAGEHOLDER PREMISE NO. BUILDING NO. CENTENNIAL LENDING LLC 0027 001 ITS SUCCESSORS AND/OR ASSIGNS 4112 KODIAK CT UNIT D LONGMONT, CO 80504-3431 PREMISE NO.. BUILDING NO. 0010 001 0012 001 0014 001 0016 001- 0018 001. MORTGAGEHOLDER PREMISE NO. BUILDING NO. PREMISE NO. BUILDING NO. HOUSING AUTHORITY FORT COLLINS 0003 001 0004 001 1715 W MOUNTAIN AVE 0019 001 0020 001 FT COLLINS, CO 80521-2359 0021 001 0022 001 0024 001 0025 001 AGENT 018-316- PHONE PAGE 0008 JENNIFER CLARKE 970-221-0897 BRANCH SLG040 REW 301 W MAGNOLIA ST ENTRY DATE 10-12-2012. FORT COLLINS, CO 80521-2804 BP AF 01 07 09 MEMORANDUM Stock No. 15141 I.. _I..w _.. .........:..4. [...1 .....[.. �:..I ..[ I----- C—.:...... n4f;..n Inn ...;IF ;[n nn.m nr:nn 322 05X3505250 08 000 SLG040 AMERICAN FAMILY MUTUAL INSURANCE COMPANY M ADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 MORTGAGEHOLDER PREMISE NO. BUILDING NO. COMMUNITY HOUSING CAPITAL INCORPORATED 0026 001 315 W PONCE DE LEON AVE STE 225 DECATUR, GA 30030-2494 APPLICABLE PROPERTY ENDORSEMENT CHARGES $5.00 TOTAL ADVANCE PROPERTY PREMIUM $29, 383.00 Property forms and endorsements applying to all premises and made part of this policy at time of issue: Any endorsement followed by a state abbreviation will only apply to coverages within this state. BP 06 01 01 07 BP 83 01 07 98 BP 83 02 01 07 BP 84 04 01 07 SECTION II LIABILITY AND MEDICAL EXPENSES Each paid claim for the following coverages reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II Liability in the BUSINESSOWNERS COVERAGE FORM and any attached endorsements. COVERAGE AGGREGATE LIMIT (OTHER THAN PRODUCTS COMPLETED OPERATIONS) PRODUCTS -COMPLETED -OPERATIONS AGGREGATE.LIMIT • . DAMAGE TO PREMISES RENTED TO YOU LIABILITY AND MEDICAL EXPENSES PREM 0003 BLDG 001 PREM 0004 BLDG 001 PREM 0009 BLDG 001 PREM 0010 BLDG 001 PREM 0011 BLDG 001 PREM 0012 BLDG 001 PREM 0013 BLDG 001 PREM 0014 BLDG 001 PREM 0015 BLDG 001 PREM 0016 BLDG 001 PREM 0017 BLDG 001 PREM 001.8 BLDG- 001 PREM 0019 BLDG 001 PREM 0020 BLDG 001 PREM 0021 BLDG 001 PREM 0022 BLDG 001 PREM 0024 BLDG 001 PREM 0025 BLDG 001 PREM 0026- BLDG 001 AGENT 018-316 MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON MEDICAL EXPENSES - ANY ONE PERSON PHONE LIMIT OF INSURANCE $4,000,000 $4,000,000 $50,000 $2,000,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 PAGE 0009 JENNIFER CLARKE . 970-221-0897 BRANCH SLG040 REW 301 W MAGNOLIA ST ENTRY DATE 10-12-2012 FORT COLLINS, CO 80521-2804 BP AF 01 07 09 MEMORANDUM Stock No. 15141 Includes copyrighted material of Insurance Services Office, Inc , with its permission