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HomeMy WebLinkAboutInsurance Certificate: Casa of Jackson County (2) STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH NOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS COVERAGE SUMMARY JAN 7 2016 P.O. Box 799100 Policy Number 97-ES-5238-8 Dallas. Tx 755 79-9 1 0 0 Policy Period Effective Date Expiration Date M-15-2134-FAE6 F U 12 Months JUN 1 2015 JUN 1 2016 0on976 3123 The policy period begins and ends at 12:01 am standard Addl Insured-Section II Only time atthe premisesiocation. THE CITY OF ASHLAND, ITS Named Insured OFFICERS, EMPLOYEES, & AGENTS CASA OF JACKSON COUNTY 20 E MAIN ST 613 MARKET ST ASHLAND OR 97520-1814 MEDFORD OR 97504-6125 Office Policy Automatic Renewal - If the policy period is shown as 12 months , this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Corporation Policy Premium $ 998.00 Discounts Applied: Renewal Year Years in Business Protective Devices Claim Record Prepared JAN 07 2016 © Copyright, State Farm Mutual AUtomOblle Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Serwces Office, Inc., with its permission. 008290 290 Al Continued on Reverse Side of Page Page 1 of 7 N 5311 eEma) nti ~ti ~n1~ f"ir.,0310 DECLARATIONS (CONTINUED) Office Policy for THE CITY OF ASHLAND, ITS Policy Number 97-ES-5238-8 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase- Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 613 MARKET ST $ 367,900 $ 38,600 25% MEDFORD OR 97504-6125 002 304 NW D ST No Coverage $ 10,400 25% GRANTS PASS OR 97526-2044 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEX(ES) Cov A - Inflation Coverage Index: 158.9 Cov B - Consumer Price Index: 238.3 SECTION I - DEDUCTIBLES Basic Deductible $500 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Prepared JAN 07 2016 10 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008290 Continued on Next Page Page 2 of 7 DECLARATIONS (CONTINUED) Office Policy for THE CITY OF ASHLAND, ITS Policy Number 97-ES-5238-8 Equipment Breakdown $500 Other deductibles may apply - refer to policy. SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises See Schedule Off Premises See Schedule Arson Reward $5,000 Back-Up Of Sewer Or Drain See Schedule Collapse Included Damage To Non-Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25°% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) See Schedule Money And Securities (On Premises) See Schedule Money Orders And Counterfeit Money $1,000 Prepared JAN 07 2016 q Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008291 290 Continued on Reverse Side of Page Page 3 of 7 N DECLARATIONS (CONTINUED) Office Policy for THE CITY OF ASHLAND, ITS Policy Number 97-ES-5238-8 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Ordinance Or Law - Equipment Coverage Included Outdoor Property See Schedule Personal Effects (applies only to those premises provided Coverage B - Business $5,000 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business See Schedule Personal Property) Signs See Schedule Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises See Schedule Off Premises See Schedule Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - SCHEDULE The coverages and corresponding limits shown below apply only to the described premises as shown. LIMIT OF LOCATION COVERAGE INSURANCE 0001 Back-Up Of Sewer Or Drain $15,000 Accounts Receivable (On Premises) $50,000 Accounts Receivable (Off Premises) $15,000 Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Outdoor Property $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Prepared JAN 07 2016 (T, Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc,., with its permission. 008291 Continued on Next Page Page 4 of 7 DECLARATIONS (CONTINUED) Office Policy for THE CITY OF ASHLAND, ITS Policy Number 97-ES-5238-8 Signs $2,500 Valuable Papers and Records (On Premises) $50,000 Valuable Papers and Records (Off Premises) $15,000 0002 Accounts Receivable (On Premises) $50,000 - Accounts Receivable (Off Premises) $15,000 Back-Up Of Sewer Or Drain $15,000 - Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Outdoor Property $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Valuable Papers and Records (On Premises) $50,000 Valuable Papers and Records (Off Premises) $15,000 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. LIMIT OF COVERAGE INSURANCE Dependent Property - Loss Of Income $5,000 Employee Dishonesty $10,000 Utility Interruption - Loss Of Income $10,000 Loss Of Income And Extra Expense Actual Loss Sustained - 12 Months SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Prepared JAN 07 2016 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008292 290 Continued on Reverse Side of Page Page 5 of 7 N DECLARATIONS (CONTINUED) Office Policy for THE CITY OF ASHLAND, ITS Policy Number 97-ES-5238-8 Coverage M - Medical Expenses (Any One Person) $10,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $4,000,000 General Aggregate $4,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form CMP-4237 Amendatory Endorsement CMP-4819.1 Unauthorized Business Card Use CMP-4705 Loss of Income & Extra Expnse CMP-4710 Employee Dishonesty CMP-4704 Dependent Prop Loss of Income CMP-4709 Money and Securities CMP-4706 Back-Up of Sewer or Drain CMP-4703 Utility Interruption Loss Incm FE-6999.2 Terrorism Insurance Cov Notice CMP-4862 Building Ordinance or Law Cov CMP-4684 Addl Insd Owners Lessee Sched CMP-4795 Addl Insd Designated Premises CMP-4787 Waiver of Trans Rgt of Recov FD-6007 Inland Marine Attach Dec Prepared JAN 07 2016 ;c) Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008292 Continued on Next Page Page 6 of 7 DECLARATIONS (CONTINUED) Office Policy for THE CITY OF ASHLAND, ITS Policy Number 97-ES-5238-8 This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President Prepared JAN 07 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008293 290 Page 7 of 7 N 97-ES-5238-8 008293