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Home My WebLink AboutInsurance Certificate: Casa of Jackson County STATE FARM FIRE AND CASUALTY COMPANY A sTOCx c, MP.ANY WITH H` MF_ OFL ICFS IN BLOOMINGTON, ILLINOIs RENEWAL DECLARATIONS P.O Box 79_~_Policy Number 97-ES-5238-8 Dallas, rX i 9-.9100 Addl Insured-Section II Only Policy Period Effective Date Ex iration Date AT2 M-15-2134-FAE6 F U 12 Months JUN 1 2016 JUAN 1 2017 uazo4~1 3i2~ The policy period beggins and ends at 12:0? am standard I THE CITY OF ASHLAND, ITS time atthe premisesTocation. OFFICERS, EMPLOYEES, & AGENTS 20 E MAIN ST Named Insured ASHLAND OR 97520-1814 CASA OF JACKSON COUNTY 613 MARKET ST MEDFORD OR 97504-6125 lllllllllllllllllllllllll~~llllllllllllllllllllllf 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 effect for 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 NOTICE- Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM $ 1,018.00 Discounts Applied: Renewal Year Years in Business Protective Devices Claim Record Prepared APR 07 2016 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 012899 294 Al Continued on Reverse Side of Page Page 1 of 7 YiO h8hii? Uh 31 ?011 Iolf3:flu! RENEWAL 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 $ 373,800 $ 38.700 25% MEDFORD OR 97504-6125 002 304 NW D ST No Coverage $ 10,500 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: 161.5 Cov B - Consumer Price Index: 238.7 SECTION 1 - DEDUCTIBLES Basic Deductible $500 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 i i I Prepared APR 07 2016 Copyright, State Farm Mutual AUtDmoblle Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc, with its permission. 012899 Continued on Next Page Page 2 of 7 RENEWAL 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. f 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 100% 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 APR 07 2016 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 012000 294 Continued on Reverse Side of Page Page 3 of 7 N RENEWAL 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 j Outdoor Property $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Prepared APR 07 2016 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, hic , with its permission. 012900 Continued on Next Page Page 4 of 7 RENEWAL DECLARATIONS (CONTINUED) Office Policy for THE CITY OF ASHLAND, ITS Policy Number 97-ES-5238-8 F; 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 f 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 APR 07 2016 Copyright, State Farm Wt!ial Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 012901 294 Continued on Reverse Side of Page Page 5 of 7 N RENEWAL 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 FE-6999.2 *Terrorism Insurance Cov Notice CMP-4237 Amendatory Endorsement CMP-4862 Building Ordinance or Law Cov CMP-4706 Back-Ur) of Sewer or Drain CMP-4684 Addl Insd Owners Lessee Sched CMP-4819.1 Unauthorized Business Card Use CMP-4704 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4703 Utility Interruption Loss Incm CMP-4705 Loss of Income & Extra Expnse CMP-4795 Addl Insd Designated Premises CMP-4787 Waiver of Trans Rgt of Recov FD-6007 Inland Marine Attach Dec * New Form Attached i Prepared APR 07 2016 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc , nith its permission. 012901 Continued on Next Page Page 6 of 7 RENEWAL DECLARATIONS (CONTINUED) Office Policy for THE CITY OF ASHLAND, ITS Policy Number 97-ES-5238-8 y 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. )1~1 - Secretary President NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or, as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. Prepared APR 07 2016 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., vvith its permission. 012902 294 Page 7 of 7 N STATE FARM FIRE AND CASUALTY COMPANY a S10-i< (";V ANY W1TH HOME OF~rGES IN BLGOMrNGTON, ILL~NOrs INLAND MARINE ATTACHING DECLARATIONS i ~'ox , )C Policy Number 97-ES-5238-8 'h Policy Period Effective Date Expiration Date M-15-2134-FAE6 F U 12 Months JUN 1 2016 JUN 1 2017 The policy period begins and ends at 12:01 am standard Named Insured time atthe premises Tocatlon. CASA OF JACKSON COUNTY F' 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 effect for 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. 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 subsequent to the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-6867 Amend of Inland Marine Condtns FE-8743 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared APR 07 2016 Copyright, State Farm Mutual Autrmohile Insurance Company, 2008 FD-6007 I1161,10es copyrighted material of Insurance Services Office, Inc., with its permission. 012903 530 fi8l6 u1 M :31 2011 !o1132321 9-47-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 $ 25,000 S 500 Included Loss of Income and Extra Expense S 2 5, 0 0 0 Included OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY Prepared APR 07 2016 Copyright, State Farm Mutual ALItOMObile Insurance Company, 2000 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., vdith its permission 012903 530 686 u 2 0S 31 2011 10 1t32:;3c