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Home My WebLink AboutInsurance Certificate: National Research Center (3) STATE FARM FIRE ANO CASUALTY COMPANY A STOCK COMPANY` lN1TH HOME OFFICES IN Bt00MlNGTON, lttw0lS DECLARATIONS AMENDED NOV 18 2016 ~w 3 Ravini rive Policy Number 96-BU-3823-8 Aflanfa 3036-2117 Policy Period Effective Date Ex iration Date M-20-2388-FA65 F U 12 Months NOV 16 2016 N~V 16 2017 oo1~~s 3123 The policy period begins and ends at 12:01 am standard Addl Insured-Section li Only time atthe premisesTacai~on. CITY OF ASHLAND OREGON AND ITS Named Insured ELECTED OFFICIALS, OFFICERS & NATIONAL RESEARCH CENTER INC EMPLOYEES 2955 VALMONT RD STE 300 - 20 E MAIN ST BOULDER CO 80301-1360 ASHLAND OR 97520-1814 Office Policy Automatic Renewal - If the policy period is shown as 11 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 Reason for Declarations: Your policy is amended NOV 18 2016 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4786 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Sprinkler Claim Record Prepared DEC 07 2016 ~ Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Sefi~vices Office, Inc,, with its permission. 012863 290 Ai Continued on Reverse Side of Page Page 1 of 6 N ti3osa~,~ ~ o~, ~~1 >Il1! ~~,1t3~:~~~:~ DECLARATIONS (CONTINUED Office Policy far CITY OF ASHLAND OREGON AND ITS Policy Number 96-BU-3823-8 SECTION I -PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase- Premises Cavera~e A - Coverage B - Business Buildings Business Personal Personal Property Property 001 2955 VALMONT RD STE 300 Na Coverage $ 80,200 25°I° BOULDER CO 80301-1360 * 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; NIA Cav B -Consumer Price Index: 241.0 SECTION I -DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. I Prepared I DEC 07 2016 Copyright, State Fanr~ Mutual Automobile Insurance Company, ~DD8 CMP-4000 Inelurles copyrighted material of Insurance Services Office, Inc., with its permission, o12~63 Continued an Next Page Page 2 of 6 i DECLARATIONS (CONTINUED) Office Policy for CITY OF ASHLAND OREGON AND iTS Policy Number 96-BU-3823-8 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 $50,000 Off Premises $15,000 Arson Reward $5,000 Back-Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non-Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered lass 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) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B -Business Personal Praperty) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A -Buildings) Prepared DEC 07 2016 0 Copyright, State Farm Mutual Autoir~obile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services 9ffice, InG., with its permission. 012864 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF ASHLAND OREGON AND ITS Policy Number 96-RU-3823-8 Ordinance Or Law -Equipment Coverage Included Outdoor Property $5,a0a Personal Effects (applies only to those premises provided Coverage B -Business $S,Oaa Personal Property} Personal Property Off Premises $15,a0a Pollutant Clean Up And Removal $1 a,a0a Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B -Business $2,500 Personal Property) Signs $2,5aa Unauthorized Business Card Use $5,x00 Valuable Papers And Records On Premises $1 a0,a00 Off Premises $15,aaa Water Damage, Other Liquids, Powder Dr Molten Material Damage Included 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 $1 a,aa0 Utility Interruption -Loss Of Income $1 a,00a Loss Of Income And Extra Expense Actual Loss Sustained -12 Months Prepared DEC a7 2a16 ~ Copyright, State Farm Mutual Automobile Insurance Company, 20D8 CMP-4aa0 Includes cap~rrighted material of Insurance Services Office, Inc,, with its permission. o~2ss4 Continued on Next Page Page 4 of 6 i DECLARATIONS (CONTINUED) Office Policy for CITY OF ASHLAND OREGON AND ITS Policy Number 96-BU-3823-8 SECTION II -LIABILITY _ LIMIT OF COVERAGE INSURANCE Coverage L -Business Liability $2,000,000 Coverage M -Medical Expenses (Any One Person) $10,000 Damage To Premises Rented To Yau $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 farms and endorsements that apply, including Chase shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Farm CMP-47$6 *Addl Insd Owners Lessee Schell CMP-4206.1 Amendatory Endorsement FE-6999.2 Terrorism Insurance Cov Notice CMP-4746 Hired Auto Liability CMP-4787 Waiver of Trans Rgt of Recav CMP-4713 Excl Testing Consulting E&0 CMP-4819.1 Unauthorized Business Card Use CMP-4706 Back-Up of Sewer ar Drain CMP-4704 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4703 Utility Interruption Loss Incur Prepared DEC 07 2016 ~ Copyright, State Farm Mutual Automobile Insurance Company, 2DD8 CMP-4000 Includes copyrighted material of Insurance Services Office, Inr,., with its permission, 412865 290 Continued an Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED Office Policy for CITY OF ASHLAND OREGON AND ITS Policy Number 96-BU-3823-8 CMP-4705 Lass of Income & Extra Expnse CMP-4788 Addl Insd Mgrs Lessor of Prem CMP-4785 Addl Ins Owners Lessee Blkt CMP-4860 AI Design Person Org FE-3650 Actual Cash Value Endorsement FD-6007 Inland Marine Attach Dec * New Form Attached This policy is issued by the State Farm Fire and Casualty Company, Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended, In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. rn. Secretary President Prepared I DEC 07 2016 Copyright, State Farm Mutual Automobile Insurance Company, 20D8 CMP-4000 Inclines copyrighted material of Insurance Services Office, Inc,, with its permission, oi2$s~ ego Page 6 of 6 ~ N ; STATE FARM FIRE AND CASUALT`~ CQMPANY A srocK coMpArvv wires HoM~ o~Frc~s iN ecoon~~rvUroN, icurvors INLAND MARINE ATTACHING DECLARATIQNS 3 Ravini Drive Polic Number 96-BU-3$23-$ Aflanta ~A 3034E-21 ~7 y Policy Period Effective Date Exp iration Date M-20-2388-FA65 F U 12 Months N~V 16 2016 NQV 16 20~ 7 The policy period be9ins and ends ati2:0i am standard Named Insured time attire premises iocat~on. NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 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/Lienholder wrritten 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 an 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 Prap FE-8739 Inland Marine Conditions See Reverse for Schedule Page with Limits Prepared DEC 07 2O1 O ~ Copyright, State Farm Mutual Automobile insurance Company, DDB FD-6007 Includes copyrighted material of Insurance Ser-vices Office, Ins;., vuith its permission, ol2ass 53u s~s~.z u~ 3~ 2o~a ~~,~t~131~:i .,.r~ 3.,, a)d~im l~ti ATTACHING INIAND MARINE SCHEDULE PAGE ATTACHING INIAND MARINE ENDORSEMENT LIMiT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8743 Inland Marine Computer Prop ~ 2 5, 0 0 0 $ 5 0 0 Include d Loss of Income and Extra Expense S 2 5, 0 0 0 I n c l u d e d 3 i OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY Prepared ~ DEC 07 216 Copyright, State Farm Mutual Automobile Insurance Company, 20D8 FD-6007 Includes copyrighted material o~ Insurance Services office, Inc,, with its permission, 012866 h34 6~G a.2 U~ ;il 2Q11 (oif3Y33c1