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9/23 - 9/24 Renewal Documentsstate rarm uenerai insurance t;ompany A Stock Company With Home Offices in Bloomington, Illinois PO Box 2356 Bloomington IL:61702-2356 u N AT1 003684 32-S2 2897-FBFF F H 6 CITY OF CAMPBELL COMMUNITY DEVELOPMENT DEPARTMENT 70 N 1ST ST UPPR CAMPBELL CA 95008-1459 IIII�III�I"'�'��""IIII'I��IIII�II��I�I��III��I�I'I�II'lll� Condominium Unitownors Policy Location of Residence Premises 569 WEST CAMPBELL AVENUE CAMPBELL CA 95008-1912 Construction: Frame Year Built: 2012 HVIATIMHO-THWit MEW AMOUNT DUE: None Payment is due by PAID BY SPECIFIED PARTY Policy Number: 05-B1-MO09-7 Policy Period: 12 Months Effective Dates: SEP 07 2023 to SEP 07 2024 The policy period begins and ends at 12:01 am standard time atthe residence premises. Your State Farm Agent FIORENTINO INS AGCY INC 5520 ALMADEN EXPY SAN JOSE CA 95118-3605 Phone: (408) 927-7526 *or (408) 269-3276 Automatic Renewal If the POLICY PERIOD is shown as 12 MONTHS, this policy will be renewed automatically subject to the premiums, rules, and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lien- holder written notice in compliance with the policy provisions or as required by law. IMPORTANT MESSAGES This policy includes building code upgrade coverage of $13,910, Refer to the Important Notice for possible terms, limits, conditions, or restrictions. PREMIUM _._._ .... Annual Premium $75600 - - Your premium has already been adjusted by the following: Home Alert Discount Sprinkler Discount Home/Auto Discount Claim Record Discount Total Premium $756:00 Prepared JUL 12 z023 -�7 0_ ob Page 1 of 3 Ho-z000 ptesvvejaw 7 L�cYu� �+Y� eI`f�rCc hrrn 015962 920 Al I N WHOM) 0404-2916 W StiteFat°tnt NAMED INSURED MORTGAGEE AND ADDITIONAL INTERESTS LALONDE, JOHNELL Loss Payee NEIGHBORHOOD HOUSING SERVICES Loan Number: SILICON VALLEY 3120521000 AMERINATIONAL COMMUNITY 217 S NEWTON AVE ALBERT LEA MN 56007=2563 Loss Payee Loss Payee CITY OF CAMPBELL COMMUNITY Loan Number: STATE OF CALIFORNIA Loan Number: DEVELOPMENT DEPARTMENT N/A DEPT OF HOUSING AND COMMUNITY N/A 70 N 1 ST ST UPPR DEVELOPMENT CAMPBELL CA 95008-1459 PO BOX 952054 SACRAMENTO CA 94252-2054 SECTION I - PROPERTY COVERAGES AND LIMITS Coverage Limit of Liability A Building Property $ 139,100 B Personal Property $ 100,900 C Loss of Use $ 70,630 D Loss Assessment $ 1,000 Additional Coverages Arson Reward $1,000 Credit Card, Bank Fund Transfer Card, Forgery, and Counterfeit. Money $1,000 Debris Removal Additional 5% available/$1,000 tree debris Fire Department Service Charge $500 per occurrence Fuel Oil Release $10,000 Locks and Remote Devices .$1,000 Trees, Shrubs, and Landscaping 5% of Coverage B amount/$750 per item SECTION II - LIABILITY COVERAGES AND LIMITS Coverage Limit of Liability L Personal Liability (Each Occurrence) $ - 100,000 Damage to the Property of Others g p y _.. 1,000 M Medical Payments to Others (Each Person) $ 1,000 INFLATION Inflation Coverage Index: 304.1 DEDUCTIBLES Section I Deductible Deductible Amount All Losses $ 500 LOSS SETTLEMENT PROVISIONS Replacement Cost - Similar Construction - Coverage A 131 Limited Replacement Cost - Coverage B H O-2000 Page 2 of 3 u 05-B1-M009-7 NO StateF rm FORMS, OPTIONS, AND ENDORSEMENTS 116-2105 Condominium Unitowners Policy HO-2408 Building Ordinance or Law f'_M HO-2362 State of Emergency Amendatory N. HO-2214 Amendatory Endorsement ADDITIONAL MESSAGES CALIFORNIA LAW REQUIRES US TO PROVIDE THE FOLLOWING NOTICE: Our records indicate that you have not purchased earthquake coverage. Anti -Fraud Disclosure - For your protection California law requires the following to appear on this form: Any person O who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. State Farm uses geographic rating that considers wildfire risk associated with your address. The range of available premium adjustments is currently -40.8% to 159.8%, and your adjustment is-36.2%. If the listed address is not correct, the premium adjustments may be impacted. To appeal the premium due to an incorrect address, please contact your State Farm® agent. Other limits and exclusions may apply - refer to your policy Your policy consists of these Declarations, the Condominium Unitowners Policy shown above, and any other forms and endorsements that apply, including those shown above as well as those issued subsequent to the issuance of this policy. This policy is issued bythe State Farm General Insurance Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm General Insurance Company has caused this policyto be signed by its President and Secretary at Bloomington, Illinois. -�� 4WO& C01144 Secretary President Prepared JUL 12 2023 Page 3 of 3 HO-2000 015963 920 N