Laserfiche WebLink
,, <br /> OHO GIP Y <br /> State Farm <br /> 23-29W8-523 <br /> IIYLFN,PATH <br /> insured: IIYLEN,PATTI Estimate: 23-29W8-523 <br /> Property: 1299 WILDIIURST TRL Claim Number: 2329W8523 <br /> ORONO,MN 55364-9644 Policy Number; 23-ED-8095-1 <br /> Honic; 50'1-726-2506 Price List: MNMN28_MAR14 <br /> Cellular; 507-380-3699 Restoration/Service/Remodel <br /> Type of Loss: Water Damage <br /> Deductible: S500.00 <br /> Date of Loss: 2/28/2014 <br /> Date Inspected: 3/25/2014 <br /> Summary for Coverage A-Dwelling- 37 Water Damage and Freezing- <br /> WR <br /> 4,549.43 <br /> Line Item Total <br /> Matt Sales Tax Reimb 93.94 <br /> 4,643.37 <br /> Subtotal 464.34 <br /> General Contractor Overhead <br /> General Contractor Profit 464.34 <br /> Replacement Cost Value(Including General Contractor Overhead and Profit) 5,572.05 <br /> Less Depreciation(Including Taxes) (1,046.95) <br /> Less General Contractor Overhead&Profit on Recoverable&Non-recoverable Depreciation (209.38) <br /> Less Deductible (500.00) <br /> Net Actual Cash Value Payment $3,815.72 <br /> Maximum Additional Amounts Available If Incurred: <br /> Total Line Item Depreciation(Including Taxes) 1,046.95 <br /> General Contractor O&P on Depreciation 209.38 <br /> Replacement Cost Benefits 1,256.33 <br /> Total Maximum Additional Amount Available If Incurred 1,256.33 <br /> Total Amount of Claim If Incurred $5,072.05 <br /> Harris,Justin ;r;_ ATTACHED D si"ir:E <br /> 866-445-7015 x 4023273452 FOR c,C-i-5 M o k c be r CXb 2 <br /> Schmidt,Pat CCD i - U i EEE E.NTS <br /> ALL AMOUNTS PAYABLE ARE SUBJECT T H E ' S,CO D O AN <br /> LIMITS OF YOUR POLICY. <br /> Please be advised any legal action concerning this claim must be initiated within 2 years from the date of loss. Any person who <br /> submits an application or files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. <br /> Date: 3/251201410:29 AM REVIEWED for CODE C MPL ANC ' Page!2 <br /> PLAN CHECKED BY4 6/,/ADATE y.-i7 --/'y <br /> Z abed ££9Z-LZP-£9L Xed dH Nd6P:10 17102 91 iciV <br />