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Home My WebLink About102621 NEIGHBOR TO NEIGHBOR - INSURANCE CERTIFICATE (20)213 05X3505250 13 000 KJR022 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY DECLARATIONS POLICY NUMBER 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 01-01-2018 TO 01-01-2019 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 stated in this policy. SECTION I PROPERTY ALL PROPERTY COVERAGES ARE SUBJECT TO THE FOLLOWING: COVERED CAUSES OF LOSS SPECIAL — RISK OF DIRECT PHYSICAL LOSS 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 362 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 AGENT 012-309 CINDY GERK AGENCY LLC 4050 S TIMBERLINE RD UNIT 100 FORT COLLINS, CO 80525-6023 PHONE 970-377-0676 PAGE 0001 BRANCH KJR022 REW ENTRY DATE 11-02-2017 BP AF 01 05 17 MEMORANDUM Stock No. 15141 213 POLICY NUMBER 05X3505250 05X3505250 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY DECLARATIONS 13 000 KJR022 CUSTOMER BILLING ACCOUNT 012-370-633 82 PREM 0013 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5,000 PREM 0014 BLDG 001 MEDICAL EXPENSES- ANY ONE PERSON $5,000 PREM 0015 BLDG 001 MEDICAL EXPENSES- ANY ONE PERSON $5,000 PREM 0016 BLDG 001 MEDICAL EXPENSES- ANY ONE PERSON $5,000 PREM 0017 BLDG 001 MEDICAL EXPENSES- ANY ONE PERSON $5,000 PREM 0018 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5,000 PREM 0019 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5,000 PREM 0020 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5,000 PREM 0021 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5,000 PREM 0022 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5,000 PREM 0024 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5,000 PREM 0025 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5,000 PREM 0026 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5,000 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 $35.00 PREMISES NO. 0004 BUILDING NO. 001 4 UNITS $17.00 PREMISES NO. 0009 BUILDING NO. 001 8 UNITS $35.00 PREMISES NO. 0010 BUILDING NO. 001 8 UNITS $35.00 PREMISES NO. 0011 BUILDING NO. 001 8 UNITS $35.00 PREMISES NO. 0012 BUILDING NO. 001 8 UNITS $35.00 PREMISES NO. 0013 BUILDING NO. 001 6 UNITS $26.00 PREMISES NO. 0014 BUILDING NO. 001 6 UNITS $26.00 AGENT 012-309 CINDY GERK AGENCY LLC 4050 S TIMBERLINE RD UNIT 100 FORT COLLINS, CO 80525-6023 BP AF 01 05 17 PHONE 970-377-0676 MEMORANDUM PAGE 0010 BRANCH KJR022 REW ENTRY DATE 11-02-2017 Stock No. 15141 213 05X3505250 13 000 KJR022 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 PREMISES NO. 0015 BUILDING NO. 001 6 UNITS PREMISES NO. 0016 BUILDING NO. 001 6 UNITS PREMISES NO. 0017 BUILDING NO. 001 6 UNITS PREMISES NO. 0018 BUILDING NO. 001 6 UNITS PREMISES NO. 0019 BUILDING NO. 001 4 UNITS PREMISES NO. 0020 BUILDING NO. 001 4 UNITS PREMISES NO. 0021 BUILDING NO. 001 11 UNITS PREMISES NO. 0022 BUILDING NO. 001 3 UNITS PREMISES NO. 0024 BUILDING NO. 001 4 UNITS PREMISES NO. 0025 BUILDING NO. 001 4 UNITS PREMISES NO. 0026 BUILDING NO. 001 CD 8 UNITS ID 0 PREMISES NO. 0027 BUILDING NO. 001 0 0 8 UNITS 0 0 o o PREMISES NO. 0028 BUILDING NO. 001 0 cD 3136 SQUARE FOOTAGE cM ml AGENT 012-309 CINDY GERK AGENCY LLC 4050 S TIMBERLINE RD UNIT 100 FORT COLLINS, CO 80525-6023 BP AF 01 05 17 PHONE 970-377-0676 MEMORANDUM 012-370-633 82 $26.00 $26.00 $26.00 $26.00 $17.00 $17.00 $48.00 $13.00 $17.00 $17.00 $35.00 $35.00 $81.00 PAGE 0011 BRANCH KJR022 REW ENTRY DATE 11-02-2017 Stock No. 15141 213 05X3505250 13 000 KJR022 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 APPLICABLE BUSINESS LIABILITY ENDORSEMENT CHARGES $253.00 TOTAL ADVANCE BUSINESS LIABILITY PREMIUM $881.00 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 09 01 06 BP 04 16 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 10 05 07 02 BP 14 60 06 10 BP 14 65 06 10 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 $61, 794.00 This premium may be subject to adjustment. 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 11 13 BP 05 01 07 02 BP 05 15 01 15 BP 05 24 01 15 BP 05 41 01 15 BP 80 01 05 17 AUTHORIZED �i" � � C ,/ COUNTERSIGNED REPRESENTATIVE President Secretary LICENSED RESIDENT AGENT AGENT 012-309 PHONE CINDY GERK AGENCY LLC 970-377-0676 4050 S TIMBERLINE RD UNIT 100 FORT COLLINS, CO 80525-6023 BP AF 01 05 17 MEMORANDUM PAGE 0012 BRANCH KJR022 REW ENTRY DATE 11-02-2017 Stock No. 15141 213 05X3505250 13 000 KUR022 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 362 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 362 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 362 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 362 AGENT 012-309 CINDY GERK AGENCY LLC 4050 S TIMBERLINE RD UNIT 100 FORT COLLINS, CO 80525-6023 PHONE 970-377-0676 PAGE 0002 BRANCH KJR022 REW ENTRY DATE 11-02-2017 BP AF 01 05 17 MEMORANDUM Stock No. 15141 Cl 0 0 0 0 M 2 Cl O O 0 o 0 0 0 S 0 213 05X3505250 13 000 KJR022 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 DESCRIPTION OF PREMISES PREMISES NO. 0012 BUILDING NO. 001 LOCATION 1550 BLUE SPRUCE BLDG 4 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 362 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 362 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 362 DESCRIPTION OF PREMISES PREMISES NO. 0015 BUILDING NO. 001 LOCATION 1550 BLUE SPRUCE BLDG 7 FT COLLINS CO 80524 AGENT 012-309 CINDY GERK AGENCY LLC 4050 S TIMBERLINE RD UNIT 100 FORT COLLINS, CO 80525-6023 PHONE 970-377-0676 PAGE 0003 BRANCH KJR022 REW ENTRY DATE 11-02-2017 BP AF 01 05 17 MEMORANDUM Stock No. 15141 213 POLICY NUMBER 05X3505250 05X3505250 13 000 KJR022 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY DECLARATIONS CUSTOMER BILLING ACCOUNT 012-370-633 82 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 362 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 362 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 362 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 AGENT 012-309 CINDY GERK AGENCY LLC 4050 S TIMBERLINE RD UNIT 100 FORT COLLINS, CO 80525-6023 PHONE 970-377-0676 PAGE 0004 BRANCH KJR022 REW ENTRY DATE 11-02-2017 BP AF 01 05 17 MEMORANDUM Stock No. 15141 0 CD 0 Ln 0 0 r- CD 0 0 0 0 0 0 Cl 213 05X3505250 13 000 KUR022 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY DECLARATIONS POLICY NUMBER CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 362 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 362 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 362 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 362 AGENT 012-309 CINDY GERK AGENCY LLC 4050 S TIMBERLINE RD UNIT 100 FORT COLLINS, CO 80525-6023 PHONE 970-377-0676 PAGE 0005 BRANCH KJR022 REW ENTRY DATE 11-02-2017 BP AF 01 05 17 MEMORANDUM Stock No. 15141 213 05X3505250 13 000 KJR022 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 DESCRIPTION OF PREMISES PREMISES NO. 0022 BUILDING NO. 001 LOCATION 1051 1055 W 8TH ST LOVELAND CO 80538 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 362 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 362 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 'FEAR BUILT 1980 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 362 DESCRIPTION OF PREMISES PREMISES NO. 0026 BUILDING NO. 001 LOCATION 2404 CLEARVIEW AVE FT COLLINS, CO 80521-4164 AGENT 012-309 CINDY GERK AGENCY LLC 4050 S TIMBERLINE RD UNIT 100 FORT COLLINS, CO 80525-6023 PHONE 970-377-0676 PAGE 0006 BRANCH KJR022 REW ENTRY DATE 11-02-2017 BP AF 01 05 17 MEMORANDUM Stock No. 15141 213 05X3505250 13 000 KJR022 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. 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 JOISTED MASONRY YEAR BUILT 1960 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 362 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 362 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 362 The Fallowing Applies To All Premises Identified In This Declaration 0 0 o POLICY PROPERTY DEDUCTIBLE $1, 000 ID co CD OTHER PROPERTY DEDUCTIBLE(S) OPTIONAL COVERAGE/GLASS DEDUCTIBLE $500 o SEWER BACKUP AND SUMP OVERFLOW DEDUCTIBLE $500 0 0 CD CD COVERAGE LIMIT OF INSURANCE PREMIUM BUILDING -Blanket $15,649,102 $58,349.00 REPLACEMENT COST AUXILIARY BUILDINGS/STRUCTURES - Blanket $359, 285 $817.00 AGENT 012-309 PHONE PAGE 0007 CINDY GERK AGENCY LLC 970-377-0676 BRANCH KJR022 REW 4050 S TIMBERLINE RD UNIT 100 ENTRY DATE 11-02-2017 FORT COLLINS, CO 80525-6023 BP AF 01 05 17 MEMORANDUM Stock No. 15141 213 POLICY NUMBER 05X3505250 REPLACEMENT COST 05X3505250 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY DECLARATIONS BUSINESS PERSONAL PROPERTY - Blanket REPLACEMENT COST AUTOMATIC INCREASE IN COVERAGE 4% ADDITIONAL COVERAGE BUSINESS INCOME OTHER COVERAGES OR OPTIONS SEWER BACKUP AND SUMP OVERFLOW ORDINANCE OR LAW COVERAGE 13 000 KJR022 CUSTOMER BILLING ACCOUNT 012-370-633 82 $160,228 $421.00 LIMIT OF INSURANCE PREMIUM ACTUAL LOSS SUSTAINED INCLUDED LIMIT OF INSURANCE PREMIUM $5,000 $1,029.00 SEE BP 04 46 $292.00 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 85 17 09 15 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. PREMISE NO. BUILDING NO. WELLS FARGO BANK NA #708 0010 001 0011 001 ITS SUCCESSORS AND/OR ASSIGNS 0012 001 0013 001 PO BOX 5708 0014 001 SPRINGFIELD, OH 45501-5708 MORTGAGEHOLDER LOAN NO. 54113431 54113669 GUARANTY BANK AND TRUST CO ITS SUCCESSORS AND/OR ASSIGNS PO BOX 5847 DENVER, CO 80217-5847 MORTGAGEHOLDER LOAN NO. 2335 CENTENNIAL LENDING LLC ITS SUCCESSORS AND/OR ASSIGNS 4112 KODIAK CT UNIT D LONGMONT, CO 80504-3431 AGENT 012-309 CINDY GERK AGENCY LLC 4050 S TIMBERLINE RD UNIT 100 FORT COLLINS, CO 80525-6023 BP AF 01 05 17 PREMISE NO. BUILDING NO. PREMISE NO. BUILDING NO. 0009 001 0010 001 0011 001 0012 001 0013 001 0014 001 0015 001 0016 001 0017 001 0018 001 PREMISE NO. BUILDING NO. 0027 001 PHONE 970-377-0676 MEMORANDUM PAGE 0008 BRANCH KJR022 REW ENTRY DATE 11-02-2017 Stock No. 15141 0 0 0 0 zo 0 0 0 0 0 0 co 0 0 0 0 0 213 05X3505250 13 000 KUR022 AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY DECLARATIONS POLICY NUMBER CUSTOMER BILLING ACCOUNT 05X3505250 012-370-633 82 MORTGAGEHOLDER PREMISE NO. BUILDING NO. PREMISE NO. BUILDING NO. HOUSING AUTHORITY FORT COLLINS 0019 001 0020 001 1715 W MOUNTAIN AVE 0021 001 0022 001 FT COLLINS, CO 80521-2359 0024 001 0025 001 MORTGAGEHOLDER COMMUNITY HOUSING CAPITAL INCORPORATED 315 W PONCE DE LEON AVE STE 225 DECATUR, GA 30030-2494 PREMISE NO. BUILDING NO 0009 001 0016 001 0018 001 PREMISE NO. BUILDING NO. 0015 001 0017 001 0026 001 APPLICABLE PROPERTY ENDORSEMENT CHARGES $5.00 TOTAL ADVANCE PROPERTY PREMIUM $60, 913.00 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 Except for Damage To Premises Rented To You, 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 LIMIT OF INSURANCE AGGREGATE LIMIT (OTHER THAN PRODUCTS COMPLETED OPERATIONS) $4, 000, 000 PRODUCTS -COMPLETED OPERATIONS AGGREGATE LIMIT $4, 000, 000 DAMAGE TO PREMISES RENTED TO YOU - ANY ONE PREMISES $50, 000 LIABILITY - EACH OCCURENCE LIMIT $2, 000, 000 PREM 0003 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5 , 000 PREM 0004 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5, 000 PREM 0009 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5, 000 PREM 0010 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5 , 000 PREM 0011 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5, 000 PREM 0012 BLDG 001 MEDICAL EXPENSES - ANY ONE PERSON $5,000 AGENT 012-309 CINDY GERK AGENCY LLC 4050 S TIMBERLINE RD UNIT 100 FORT COLLINS, CO 80525-6023 PHONE 970-377-0676 PAGE 0009 BRANCH KJR022 REW ENTRY DATE 11-02-2017 BP AF 01 05 17 MEMORANDUM Stock No. 15141