The Cincinnati Casualty Company POLICY NUMBER

T01 1132740
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TENANT SPECIAL
DECLARATIONS
Policy Period: From 05/16/2023 To 05/16/2024
12:01 a.m. Standard Time at the Address of the Named Insured
New Business

T01 1132740 Please refer any questions to your agent:

Named Insured & Address Integrity Insurance & Bonding Inc.
Abhi Bhel 9201 SE 91ST AVE STE 220
HAPPY VALLEY, OR 97086-3760
1022 NW MARSHALL ST UNIT 390, 503-777-6655
PORTLAND OR 97209-3576

Agency 36074

County of MULTNOMAH
In the event of a claim, you may call your
agent or The Cincinnati Casualty Company
at 877-242-2544.

Unless otherwise stated, the residence premises covered by this policy is located at the above address.

PAYOR - Account

Billing Method: Direct Bill

Current Pay Plan: Annual Pay
Total Premium: $948.00

THIS IS NOT A BILL. You will receive a separate invoice if a premium charge or return is due.

COVERAGES AND LIMITS OF INSURANCE

SECTION I C. Personal Property $130,000

D. Loss of Use Actual Loss

DEDUCTIBLE (SECTION I ONLY)

$500 Applies to all causes of loss unless otherwise noted.

SECTION II E. Personal Liability

a. Bodily Injury and Property Damage
(per Each Occurrence)
b. Personal Injury (Aggregate) } $300,000
F. Medical Payments to Others - Each Person $5,000
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 The Cincinnati Casualty Company POLICY NUMBER
T01 1132740
Image 1
TENANT SPECIAL
DECLARATIONS
Policy Period: From 05/16/2023 To 05/16/2024
12:01 a.m. Standard Time at the Address of the Named Insured New Business

The following credits have been applied to your policy:

Advance Quote Credit
Pay Plan Discount
Preferred Loss History Credit
Secured Community Credit
Surveillance Camera Credit

BASIC PREMIUM SUBTOTAL $365.00

OTHER COVERAGES, ENDORSEMENTS AND CHARGES

Tenants - Special Form Your Tenant Policy Tenant(S)AQ (6/17)
Tenant (Special) Special Provisions Endorsement - Oregon HR1030QOR (1/22)
Trade or Economic Sanctions Endorsement Notice of IP462 (1/18)
Privacy Practices MI1659 (6/18)
Your Insurance Score MI1785A (4/19)
Oregon Fraud Statement MI1995OR (1/12)
Special Large Deductible Endorsement HOA900AA (6/17)
Personal Articles Endorsement - Oregon HR1007QOR (6/17) $583.00
Section I - Fungi, Wet or Dry Rot, or Bacteria - Limit of Included
Insurance Schedule ($10,000)
Section II - Fungi, Wet or Dry Rot, or Bacteria - Limit of Included
Insurance Schedule ($50,000)

OTHER COVERAGES, ENDORSEMENTS AND CHARGES PREMIUM $583.00

TOTAL POLICY PREMIUM $948.00

Personal Articles Endorsement

Schedule:
Class: Description: Blanket per item limit: Deductible: Limit: Premium:
Jewelry Diamond Ring $0 $15,500 $153.00
Jewelry Watch $0 $11,500 $114.00
Jewelry Diamond Earrings $0 $15,500 $153.00
Jewelry Diamon Pendant $0 $16,500 $163.00

Total $59,000 $583.00

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