CORPORATE HEADQUARTERS MAILING ADDRESS

5600 BEECH TREE LANE P.O. BOX 2450

CALEDONIA, MI 49316-0050 GRAND RAPIDS, MI 49501-2450

INSURANCE ESTIMATE
Company: Foremost Prepared on: 08/13/2021

Reference Number: 5006593386 Policy Period: 08/19/2021 - 08/19/2022

Insured Name: MICHAEL FERNHOLZ Mailing Address: 2412 W 86TH TER

LEAWOOD, KS 66206-1520

Program: Condo DF6

Dwelling Information
Location: 10752 OAKMONT ST Year Built: 1979 Territory: A
OVERLAND PARK, KS 66210-1139 Protection Class: 1 Occupancy: Vacant / Unoccupied

Coverages/Endorsements Total Coverage Amt Deductible Premium

Unit Owners Building $135,000 $2,500 $719
Premises Liability $500,000 $100
Medical Payments $500 Incl

Discounts/Surcharges
Claims Free Discount -$8
Multi-Policy Discount -$41
Permitted Vacancy Surcharge $82

Taxes & Fees: $0.00

Total Premium: $852.00
Form 736240 10/15 “Foremost” and the “F” logo are registered trademarks of FCOA, LLC, 5600 Beech Tree Lane, Caledonia, MI 49316.
 CORPORATE HEADQUARTERS MAILING ADDRESS
5600 BEECH TREE LANE P.O. BOX 2450
CALEDONIA, MI 49316-0050 GRAND RAPIDS, MI 49501-2450

INSURANCE ESTIMATE

Insured Name: MICHAEL FERNHOLZ

Reference Number: 5006593386

Payment Options Available

No. of Payments 1 Pay 2 Pay 4 Pay 12 Pay - EFT Only

Premium Due $852.00 $426.00 $213.00 $74.19

Surcharge
Service Fee $6.00 $6.00 $2.00

Amount Due Now $852.00 $432.00 $219.00 $76.19

Amount of Each
Remaining Payment $432.00 $219.00 $72.71

Next Payment Due 01/31/2022 11/02/2021 09/13/2021

12 pay option requires enrollment in Automated Electronic Funds (EFT). N/A in Colorado or Texas.
Your Foremost Producer:
PATRICK WERTZBERGER INS AGENCY INC
10560 BARKLEY ST #330
OVERLAND PARK, KS 662121843
913-383-3276
THIS IS AN ESTIMATE FOR INSURANCE ONLY AND NOT A POLICY BINDER.
THE POLICY WILL BE SUBJECT TO CONFIRMATION OF PREMIUMS, PROPERTY INSPECTION,
CONSUMER REPORTS, AND NORMAL COMPANY UNDERWRITING INVESTIGATION.

“Foremost” and the “F” logo are registered trademarks of FCOA, LLC, 5600 Beech Tree Lane, Caledonia, MI 49316.

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