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HomeMy WebLinkAboutInsurance Certificate: Casa of Jackson County (3) STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON. ILLINOIS INLAND MARINE ATTACHING DECLARATIONS P.O. Box 799100 Policy Number 97-ES-5238-8 Dallas. TX 753 79-9 1 00 Policy Period Effective Date Expiration Date M-15-2134-FAE6 F U 12 Months JUN 1 2015 JUN 1 2016 The policy period begins and ends at 12:01 am standard Named Insured time atthe premises Tocatlon. CASA OF JACKSON COUNTY 613 MARKET ST MEDFORD OR 97504-6125 ATTACHING INLAND MARINE 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/Lien holder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8743 Inland Marine Computer Prop FE-8739 Inland Marine Conditions FE-6867 Amend of Inland Marine Condtns See Reverse for Schedule Page with Limits Prepared JAN 07 2016 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc„ with its permission. 008294 530 1366 v.2 M'31 7011 1o1 13732c! 97-ES-5238-8 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8743 Inland Marine Computer Prop S 25,000 5 500 Included Loss of Incorne and Extra Expense $ 25 , 0 0 0 Included OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY Prepared JAN 07 2016 (T% Copyright, State Farm Mutual Automobile Insurance Company, 20D8 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008294 530 686 1.7 US 31 7011 fut(37330 97-ES-5238-8 008295 CMP-4684 Page 1 of i THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4684 ADDITIONAL INSURED OWNERS, LESSEES, OR CONTRACTORS O (Scheduled) This endorsement modifies insurance provided under the following. BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 97-ES-5238-8 Named Insured: CASA OF JACKSON COUNTY 613 MARKET ST MEDFORD OR 97504-6125 Name And Address Of Additional Insured Person Or Organization: THE CITY OF ASHLAND ITS OFFICERS, EMPLOYEES, & AGENTS 20 E MAIN ST ASHLAND OR 97520-1850 1. SECTION 11 - WHO IS AN INSURED of SECTION II - LIABILITY is amended to include, as an additional insured, any person or organization shown in the Schedule, but only. a. Ongoing Operations With respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused by your ongoing operations for that additional insured and only to the extent that such "bodily injury", "property damage" or "personal and advertising injury" is caused by your negligence or the negligence of those performing operations on your behalf, or b. Products-Completed Operations To the extent that the liability for "bodily injury" or "property damage" is caused by "your work" per- formed for that additional insured and included in the "products-completed operations hazard". 2. Any insurance provided to the additional insured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insurance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provid- ed by you. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. CMP-4684 Copyright. State Farm Mutual Automobile Insurance Company, 2011 Includes copyrighted material of Insurance Services Office. Inc. with its permission 97-ES-5238-8 008296 CIMP-47871 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SIAiF IApM CMP-4787 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST a•, OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 97-ES-5238-8 Named Insured: CASA OF JACKSON COUNTY 613 MARKET ST MEDFORD OR 97504-6125 Name and Address of Person or Organization: THE CITY OF ASHLAND ITS OFFICERS, EMPLOYEES, & AGENTS 20 E MAIN ST ASHLAND OR 97520-1850 The following is added to Paragraph 10.b. of SECTION I AND SECTION II - COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of. a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission.