Laserfiche WebLink
PRIMARY FLOOD POTICY <br />RENEWAT DECIARATIONS <br />NAMED INSURED & MAILING ADDBESS <br />PATRICK VAN DE VENTER <br />1430 N FERGUSON RD <br />ELLENSBURG, WA 98926 <br />Thls Certiflcate shall not be valld unless signed by Johnson & Johnson lnc' <br />oated tDl28l2125 at Charleston, South carollna. <br />POLICY NUMBER: GPF920O288A <br />REIIEWAL OF POUCY iIUMBER3 GPR920O!88 <br />COMPAI{Y NUMBEN 844 <br />AGEI{CY ttIAME & ADDRCSS <br />805619 . ROTHERT AND ASSOCIATES <br />PO BOX 13099 <br />PORTLAND,, OR 97213 <br />(s03) 2s2-s4s4 <br />pollcy perlod: Frcrattlttlzoils 12:00;o0AM to tuL3l2u26 I2:00:0OAM 12:Ol 6.m. Standard rlme at the Descdbed I'ocatlon(sl <br />fu,*2% <br />This certificate of Insurance is issued in accordance wlth the authorizatlon granted under contract No. RF03801A25 Undersigned by <br />creat Lakes lnsurance sE, herein after called "the company". This insurance applies to the Descrlbed Location(s), cwerage for whlch a <br />Llmlt or Premium is sholvn and Perils lnsured ASainst for whlch a Premlum ls stated. <br />THIS CONTRACT IS REGISTERED AND DELIVERED AS A SURPLUS LINE COVERAGE UNDER THE INSURANCE <br />CODE OF THE STATE OF WASHINGTON, TITLE 48 RCW. IT IS NOT PROTECTED BY ANY WASHINGTON STATE <br />GUARANW ASS'OCIATION LAW.JOHNSON & JOHNSON INC - LIC #8US851285 <br />BASE PREMIUM <br />POLICY FEE <br />STATE TAX <br />STAMPING FEE <br />TOTAL <br />$1,127.00 <br />$75.00 <br />$24.04 <br />$3.61 <br />$1,229.65 <br />NO FI.ATCANCELLATIONS <br />EARNED PREIIIUII: <br />LocATloN fl . t430 N FERGusoN RD Et[E'{sBuRG, wA 9E91& KITTIIAS coullw <br />OCCUPANCY TVPE; PRIMARY <br />CONSTRUCnON TYPE: FRAME <br />YEARBUILT:2006 <br />NUMEER OF STORIES: 2 <br />SqUAREFOOTAGE: 1,386 <br />DISTANCE TO COAST: GREATER THAN 31 MILES <br />FLOOD ZONE: A <br />ISTHE BUIIDING SITUATED OVER WATER: NO <br />CBRA: NO <br />Bulldlng Replacement Cost, 5275,625'W <br />Personal Property Replscement Cose 596,468,00 <br />ISTHE EUILDING EIEVATED: YES <br />I{EIGHT ABOVE GROUND OF IOWEST OCCUP]ED <br />FtOoR lFil: 1 <br />ELEVATIOI,I TYPE: CRAWLSPACE <br />ELEVAIION STATUS: UNFINISHED <br />FOUNDANON TYPE: SOLID FOUNDATION WALLS <br />ss,000.00 <br />5275,62s.O0 <br />$96,458.00 <br />ss5,12s,00 <br />s27,s62.0o <br />Building # t <br />DEDUCNBLE: <br />DWELUT{G <br />PERSONA! PROPERTY: <br />toss oF usE: <br />OTHER SNUCTURES: <br />RATING FACTOBS & U'{DERWRMilG INFORMANOil: <br />By <br />Page 1 of 3