159 Heritage Pl. A Stock Company With Home Offices in Bloomington, Illinois
PO Box 2356 Bloomington IL 61702-2356 •• Stat@Farm.
•
AT 1 004162 320Q2 2FB1-FROG F H6
CITY OF CAMPBELL DEVELOPMENT RENEWAL DECLARATIONS
DEPARTMENT
,• H7CDNIST LOAN PROGRAM
TOGRAM
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CAMPBELL CA 95008-1458 AMOUNT DUE: None
'11IlIIIIlIIII111IIIII'lIIIIIIIII'III'II'IIII'I"0'lll'I'I'IIIII' Payment is due by TO BE PAID BY INSURED
Policy Number: 05-KJ-5212-8
•
RECEIVED
N Policy Period: 12 Months
AUG 1 4 2023 Effective Dates: SEP 28 2023 to SEP 28 2024
The policy period begins and ends at 12:01 am standard
CITY OF CAMPBELL time at the residence premises.
• FINANCE
Condominium Unitowners Policy Your State Farm Agent
HOLLY LABARBER
Location of Residence Premises 1262 E HAMILTON AVE STE 1 C
159 HERITAGE PL CAMPBELL CA 95008-0837
CAMPBELL CA 95008-3065
Phone:(408) 871-8889
Construction: Frame
Year Built: 2004
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 $1,300. Refer to the Important Notice for
possible terms,limits, conditions,or restrictions.
PREMIUM
Annual Premium • $149.00
Your premium has already been adjusted by the following:
Home Alert Discount Claim Record Discount
Total Premium $149.00
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NAMED INSURED MORTGAGEE AND ADDITIONAL INTERESTS
AYALA, CHRISTINA
Loss Payee
CITY OF CAMPBELL DEVELOPMENT Loan Number:
DEPARTMENT N/A
HCD LOAN PROGRAM
70 N 1ST ST
CAMPBELL CA 95008-1458
Additional Insured
HOUSING TRUST SILICON VALLEY Loan Number:
75 E SANTA CLARA ST STE 1350 N/A
SAN JOSE CA 951 1 3-1 838
SECTION I -PROPERTY COVERAGES AND LIMITS
Coverage Limit of Liability
A Building Property $ 13,000
B Personal Property $ 4,300
C Loss of Use $ .3,010
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) $ 300,000
Damage to the Property of Others $ 1,000
M Medical Payments to Others (Each Person) $ 1,000
INFLATION
Inflation Coverage Index: 305.1
DEDUCTIBLES
Section I Deductible Deductible Amount
All Losses $ 1,000
LOSS SETTLEMENT PROVISIONS
Replacement Cost - Similar Construction - Coverage A
B2 Depreciated Loss Settlement - Coverage B
HO-2000
Page 2 of 3
05-KJ-5212-8 As State Farm.
FORMS, OPTIONS,AND ENDORSEMENTS
H6-2105 Condominium Unitowners Policy
Option Al Additional Insured
HO-2408 Building Ordinance or Law
HO 2362 State of Emergency Amendatory
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.
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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 by the 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 policy to be signed by its President and
Secretary at Bloomington, Illinois.
-m. 4, . !,
Secretary President
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