Policy Renewal 565 W. Campbell AvePOLICY NO: 0135lbS19 9UA .,MUNU MUKIUAUtt NUIlrlIAIlUIV VO/1t/cVu
HOMEOWNER POLICY
POLICY EFFECTIVE DATE: 09/07/2023 INSURER: USAA CASUALTY INSURANCE COMPANY
POLICY EXPIRATION DATE: 09/07/2024
LOAN NO:
POLICY RENEWAL EFFECTIVE AS OF 09/07/2023
SECOND MORTGAGE CO: CITY OF CAMPBELL
INSURED: MATTHEW T. WISNIESKI, A SINGLE MAN COMMUNITY DEV DEPARTMENT
PROPERTY: 565 W CAMPBELL AVE 70 N 1ST ST
CAMPBELL CA 95008 CAMPBELL CA 95008-1458
TOTAL PREMIUM $ 500.59 AGENCY:
DEDUCTIBLE $ 500.00
DWELLING COVERAGE LIMIT $ 14,000
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PO BOX 659464
SAN ANTONIO TX 78265 RETURN SERVICE REQUESTED
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ALL STATES EXCEPT UTAH: This certificate of i issued a matter of information
only and confers n rights upon the certificate holder. This certificate of insurance does not
affirmatively o negatively a end, extend, o alter the coverage terms, exclusions and
Cconditions afforded by the i e policy or policies referenced herein. This i not a
e policy. Notwi thstandin gn any requirement, term, or condition of any contract o other
document with respect to which this certificate may be issued ormay rtain, thnce
afforded by the policiedescribed herein is subject to all the terms, per,.!" ex s clusionse ra, and
onditions of the policies.
UTAH: (1) A certificate of insurance i not a e policy and does not affirmatively or
negatively amend, extend, or alter these rage afforded by a insurance policy to which a
ertificate of i refers. (2) A ertificate of i mayan of confer to a
rtificate hold e rua right that is
not provided by a e policy to which the certificate
of i refers. (3)(a) A certificate of i nsurance� may insurance
refer to a ontract that i
not anuinsurance"policy, including a nstruction o ontract. (b)cNotwithstanding any
requirement, to r'm, o ondition of a document with respectctocwhi ch a ertificate of i
may be i ued o mayrpertain, the i rage afforded by a referenced i cespolicy
is be
to the terms, exclusions, and n conditions of the insurance policy itself.
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2038 1 MB 0.378
CITY OF CAMPBELL
COMMUNITY DEV DEPARTMENT
70 N 1ST ST UPPR
CAMPBELL CA 95008-1459
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