HomeMy WebLinkAboutMiscellaneous Applicant 12/22/2021Home Insurance Policy Field Issue Declarations
COUNTRY Mutual lnsurance Compant'
PO Box 2100, Bloomington lL 61702-2100
T 1 -866-COUNTRY (1 -866-268-6879)
www.countryfi nancial. com COUNTRYFINANCIAL
lnsured: Jack Hough
925 Ascot Dr
Eugene, OR 97401-5113
Pollcy Number: 4K4085045
Statuc: Actlve
Premlum Period Beglnning: 1U20n021
Premlum Perlod Endlng: 1012012022
(12:01a.m. Standard time at YOUR address)
Policy Period: Annuel
CONTINUOUS RENEWAL - This policy may be renewed automatically subject to the premiums, rules, and
endorsements in effect for each succeeding policy period. lf this policy is terminated we will give you and the
mortgagee written notice in compliance with the policy previsions required by law.
We will provide the insurance described in the policy in return for the premium in compliance with all applicable
provisions to the policy.
Location of Premises: (if different than above address).
404 18TH ST
Springfield, OR 97477
Policy Type: Peril Code: Limit of Liability:
Dwelling Home Protector 07 $210,000.00Coverage: First Annual Premium: Endorsements:
Dwelling Home Protector (B) $276.67 ENDR-044 Amendatory
(ln the case of a loss, we cover only that part of the loss over the deductible stated.)
Deductible: Wind/Hall Deductlble:
$1,000.00 N/A
Mortgagee:
Name: DEVELOPMENT & PUBLIC WORKS
Type: Additional lnsured
Address: CITY OF SPRINGFIELD 225 sTH ST
City: SPRINGFIELD
State: OR-97477
Loan No: 811-19-000297-WP2
Financial Representative Name: Katrina M Tilley
Office No: EMERALD VALLEY(OO4)
Phone: il1-3444215
Authorized Representative
12t22t2021
Date
COUNTRY Mutual lnsurance Company
P.O. Box 2100
Bloomington, lL 61702-2100
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