271 Grant St TRAVELERS
Homeowners Policy Change Declarations
Named Insured and Mailing Address Your Agency's Name and Address
MANUEL VIVEROS LOCKTON AFF C/O TRAVELERS
271 GRANT ST PO BOX 64115
CAMPBELL, CA 95008-2018 ST. PAUL, MN 55164-9955
Residence Premises
271 GRANT ST
CAMPBELL, CA 95008-2018
Mortgagee Name and Address
1. HABITAT FOR HUMANITY EAST BAY 2. CITY OF CAMPBELL
SILICON VALLEY%AMERINATIONAL 70 N 1ST ST
PO BOX 123 CAMPBELL, CA 95008-1458
DOWNEY, CA 90241-0123
LOAN NUMBER: 1000065494
Policy Information
Your Policy Number 610868844 633 1 For Policy Service 1.800.842.5075
Your Account Number 970535478 For Claim Service 1.800.252.4633
Your Insurer: THE STANDARD FIRE INSURANCE COMPANY
a subsidiary or affiliate of The Travelers Indemnity Company
One Tower Square, Hartford, CT 06183
Premium Change: This change causes no additional or return premium for the policy period.
Change Effective: September 15, 2023
Reason For Change:
Added Mortgagee 2
These Declarations replace all prior declarations on the date on which this change is effective.
The policy period is from March 8, 2023 at 12:01 A.M. STANDARD TIME to March 8, 2024 at 12:01 A.M.
STANDARD TIME at the residence premises.
:...;. ,. . . .
Discounts
The following discounts reduced your premium:
Loss Free Fire Protective Device Affinity
Savings Reflected in Your Total Premium: $169.00
PL-50355 CA(05-17) Mortgagee Copy Page D-1
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TRAVELERS
Coverages and Limits of Liability
Property Coverage Section Limit
Coverage A—Dwelling $496,000
Coverage B—Other Structures $49,600
Coverage C—Personal Property $347,200
Coverage D—Loss of Use $148,800
Liability Coverage Section Limit
Coverage E—Personal Liability- Bodily Injury and Property Damage (each occurrence) $100,000
Coverage F—Medical Payments to Others (each person) $1,000
Deductibles
Peril Deductible Deductible
Property Coverage Deductible (All Perils) $1,000
In case of loss under the Property Coverage Section, only that part of the loss over
the applicable deductible will be paid(up to the coverage limit that applies).
Special Limits and Additional Coverages The limit shown for each of the
Coverage Level: Travelers Protect Plus® Special Limits of Liability and Additional Coverages
is the total limit for each loss in that category.
Personal Property—Special Limits of Liability Limit
a. Money, bank notes, coins, stored value cards $1,000
b. Securities, accounts,.passports, tickets, stamps,.__..... $3,500
c. Comic books and trading cards $2,500
d. Collectibles, figurines, glassware, marble, porcelains, statuary $2,500
e. Theft of jewelry, watches, precious stones $3,000
f. Theft of furs $3,000
g. Theft of silverware, goldware, pewterware $5,000
h. Theft of firearms and related equipment $5,000
i. Theft of tools and their accessories $2,500
j. Theft of rugs, tapestries and wall hangings $2,500
k. Business property on the residence premises $10,000
I. Business property away from the residence premises $5,000
m. Trailers or semitrailers not used with watercraft $3,500
n. Motor vehicle parts or equipment not attached to motor vehicle $1,000
o. Electronic apparatus while in or upon a motor vehicle or watercraft $3,500
The Special Limits of Liability do not increase your Coverage C—Personal Property Limit.
Property—Additional Coverages Limit
Debris Removal (Additional % of damaged covered property limit) 5%
Tree Removal Per Tree $500 Per Loss $1,000
Trees, Shrubs and Other Plants Per Tree $500 Per Loss $24,800
(5% of Coverage A- Dwelling Limit)
PL-50355 CA(05-17) Mortgagee Copy Page D-2
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TRAVELERS
Named Insured MANUEL VIVEROS Policy Number 61 0868844 633 1
Policy Period March 8, 2023 to March 8, 2024 Issued On Date September 17,2023
Property—Additional Coverages (continued) Limit
Fire Department Service Charge $1,000
Credit Card, Fund Transfer, Forgery and Counterfeit Money $10,000
Loss Assessment $1,000
Landlord Furnishings $2,500
Ordinance or Law (10% of Coverage A- Dwelling Limit) $49,600
Personal Records and Data Replacement $3,500
Limited Fungi or Other Microbes Remediation $5,000
The applicable policy deductible applies unless otherwise noted.
Liability—Additional Coverages Limit
Damage to Property of Others $5,000
Loss Assessment $1,000
Please review your policy for other Personal Property Special Limits of Liability and Additional Coverages that may apply.
Optional Coverages
Optional Coverages Endorsement Limit Premium
Personal Property Replacement Cost Loss Settlement HQ-290 CA (04-20) Included*
Additional Replacement Cost Protection Coverage HQ-420 CA (11-18) $124,000 Included*
25% of Coverage A- Dwelling Limit
Wildfire Defense Services HQ-710 CA (05-17) Included*
`Note: The additional cost or premium reduction for any optional coverage or package
shown as"Included"is contained in the Total Policy Premium Amount.
Required Forms and Endorsements Included in Your Policy: Form: 633
Policy Quick Reference HQ-T77 CW(05-17)
Agreement, Definitions & Policy Conditions HQ-D77 CW(05-17)
Property Coverage Section HQ-P03 CW(05-17)
Liability Coverage Section HQ-L77 CW(05-17)
Signature Page HQ-S99 CW(05-17)
Special Provisions - California HQ-300 CA (07-21)
Workers' Compensation Residence Employees HQ-090 CA (05-17)
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Information About Your Property
There are many factors that determine the premium on your policy, some of which are displayed below. If you
would like a policy review, please contact your agent or Travelers Representative.
Year Built: 2000 Garage Type: Attached Pool: No
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TRAVELERS
Information About Your Property (continued)
#of Families: 1 Family Square Footage: 1383 Age of Roof: 23
#of Stories: 2 Construction Type: Frame Roof Material Type: Asphalt-Fiberglass
#of Bathrooms: 1 Siding Type:Vinyl Age of Plumbing: 23
#of Employees: 00 Foundation Type: Basement
Garage - Number of Cars: 1 Finished Basement:00
Issued on 09-17-2023
For Your Information
For information about how Travelers compensates independent agents and brokers, please visit
www.Travelers.com or call our toll free telephone number 1-866-904-8348. You may also request a written copy
from Marketing at One Tower Square, 2GSA, Hartford, Connecticut 06183.
We want to make sure we are using accurate information to rate your policy. Because you are the most familiar
with your home we need your help to make sure that the information on your Declarations is accurate and
complete. If any of the information on your Declarations has changed, appears incorrect or is missing, please
advise your agent or Travelers representative. We also need you to check our website at
www.mytravelers.com/discounts to ensure that you are receiving all of the discounts for which you are eligible.
Once at the website, type in your policy number 6108688446331 and product code CH2 to view all available
discounts. Should you have any questions about the information on your Declarations or your discounts, please
call your agent or Travelers representative.
Each home is unique and you know your home best. Your coverage amount may need to be adjusted, higher or
lower, based on your home's specific construction details, updates or upgrades. Have you recently made any
home improvements, such as upgraded your kitchen or- bath, or completed a finished living area in your
basement? Have you added an extra room or built a deck? These changes can significantly increase the
replacement cost value of your home. It is important to make sure your policy affords appropriate coverage and
limits to reflect your home's replacement cost value in the event of a total loss. If you disagree with your coverage
limit, please contact your agent or Travelers representative who can work with you to help you decide the
appropriate amount of insurance for your home and process any necessary adjustments.
Earthquake coverage is not included in this policy.
THIS POLICY INCLUDES LIMITED ORDINANCE OR LAW COVERAGE.
BUILDING CODE UPGRADE COVERAGE, also called Ordinance and Law coverage, covers additional costs to
repair or replace a dwelling to comply with the building codes and zoning laws in effect at the time of loss or
rebuilding. These costs may otherwise be excluded by your policy. Meeting current building code requirements
can add significant costs to rebuilding your home. Building Code Upgrade Coverage does not apply to Additional
Replacement Cost Protection Coverage. Refer to your policy or endorsement for the specific coverage provided
and coverage limits, conditions, or restrictions that apply.
PL-50355 CA(05-17) Mortgagee Copy Page D-4
670/0 M 6433
THE TRAVELERS
TRAVELERS BUSINESS CENTER
PO BOX 64115
ST. PAUL, MN 55164-9955
01197
CITY OF CAMPBELL
70 N 1ST ST
CAMPBELL, CA 95008
PL-50004(03-12)
I I I I 004271/01197 S1348N11 588 09/17/23
TRAVELERSJ�
To:CITY OF CAMPBELL
70 N 1ST ST
CAMPBELL, CA 95008
To whom it may concern:
Enclosed is a copy of our insured's Policy Declarations. It outlines the coverage purchased, limits and
deductibles.
This is to notify you, as mortgagee, that failure to immediately notify us of
• Any change in ownership (such as foreclosure)
• Occupancy, or
• Substantial change in risk
may result in denial of your interest in any claim that occurs under the policy.
Please take a moment to review the mortgagee information and ensure it is correct. If you have any questions,
contact us at the number displayed on the Policy Declarations at the following address:
THE TRAVELERS
TRAVELERS BUSINESS CENTER
PO BOX 64115
ST. PAUL, MN 55164-9955
Sincerely,
Travelers
PL-50438(02-22)
1111 004272/01197 S1348N11 588 09/17/23