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BAW INDIANA FARM CHURCH POLICY DECLARATIONS <br />R BUREAU INSURANCE" UNITED FARM FAMILY MUTUAL INSURANCE COMPANY <br />This deolsration form together with any forms end endot,ementr Wkaled under Kern 9 <br />conBOW[ s the entire aontraot botwoen the parties, Thfs decictatlon replaces end soporsedos <br />any prooeding numbarod didaratlans bearing the Tame policy number. <br />Poficy No. Tranaaction <br />CHU 8701592 06 RENEWAL BUSINESS <br />1. Named Insured and Mailing Address <br />LIVING STONES CHURCH <br />718 VOLNNOYER AVE <br />SOUTH BEND IN 46614 <br />Agent County <br />7601404 760 <br />First Mortgagee (Name and Address) <br />LAKE CITY BANK <br />#621163 9 <br />PO BOX 1387 <br />WARSAW IN 46581 <br />2, Polley Term: From: 12/05/2017 To: 12/05/2018 at 12:01 a.m. Standard Time at location of described premises <br />3. Location of Premises <br />01 718 DONMOYER AVV SOUTH RENR IN 4663.4 <br />02 638 DONMOY£R AVE SOUTH 13M IN 4663.4 <br />a. The Named Insured is: CORPORATION ( Church ) <br />5. SCHEDULE OF PROPERTY INSURANCE APPLIES ONLY WITH RESPECT TO THOSE COVERAGES ANP PROPERTY FOR WHICH A <br />LIMIT OF INSURANCE IS SHOWN <br />Prem. Bldg. Limits of Valuation Coverage Earthquake coverage applies <br />No. No. Insurance if % deductible is shown <br />0001 0001. $2, 225, 841 RC JOISTBD MASONRY BLDG OCCUP AS A CHURCH AND ITS WNTENTS <br />0001. 0002 $315,4.27 RC BUS GARAGnIYOUTH.BUILDINO <br />Dedueilblo 0260 unless otherwise stated $11)00 <br />Automatic Increase Real Property 3t <br />❑ Mine Subsidence - See form Church 15 <br />Unless otherwise stated in the Schedule of Property, the following Additlonal Coverages and Coverage Extensiorts apply for the limit shown <br />below. <br />inside <br />outside <br />Money and Securities $5,000 <br />45,000 <br />Employee D,Ishonesty <br />$15,000 <br />Valuable Papers and Records <br />410,000 <br />Backup of Sowers and Drains <br />$10r000- <br />Maintenanve and Service Buildings <br />015,(l00 <br />Fire, Department Service Charge <br />Actual Cost <br />Debrls Removal <br />450,000 <br />Church Income Inol. Extra Exp. & Civil Authority <br />$25,000 <br />Money Order & Counterfeit Paper Currency <br />$61000 <br />6. Liability Insurance Limits <br />Forgery & Alteration <br />55,000 <br />Ordinance or Law Coverages 2 & 3 <br />450,000 <br />Newly Acquired Buildings and Personal Property <br />1500,000 <br />Paraonal.Propar{y Off premisss <br />$15,000 <br />Outdoor Trees, Shrubs & Plant (up to $1,000 ea.)max$10,000 <br />Spoilage <br />Actual Coat <br />Fine Arts <br />05,000 <br />Personal Effoots of Clergy <br />$16,000 <br />Personal Effects of Others <br />42,500 <br />General Aggregate Limit (other than Products -Completed Operations) 0 3,000,000 <br />Products -Completed Operations Aggregate Limit S 3,000,00() <br />Personal and Advertising Injury Limit S 1,000,000 <br />Bach Occurrence Limit $ 1,000,000 <br />Fire Legal Liability Limit $ 100,000 <br />Medical Expenses Limit t 5,000 <br />Sexual Misconduct Limit $ 500,000 <br />$ 500,000 <br />7. The following options apply If checked: <br />® Hired/Nonowned Auto A Excess Medical . Day Care © Excess (Medical - Students <br />W Clergy Professional Q Excess Medical - Organized Sports ICI Directors & Officers Liability <br />0, Cllf this box is checked, Church Bus Coverage applies. See attached Church Bus Declarations Page <br />9 Farms and Endorsements Applicable In addition to Forms <br />Soo Forms inventory <br />any one fire <br />any one person <br />any one person <br />aggregate <br />© Cemetery Professional <br />10. Premfuln Annual Premium <br />$ 4,732,00 <br />Issued Date_ 10/17/201.7 <br />25-077 6-05 <br />INSURED <br />00OSG-00003 page, 1 of 1 <br />