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HomeMy WebLinkAboutInsurance Certificate: National Research Center (5) STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED NOV 30 2016 3 Ravinia Drive Policy Number 96-BU-3823-8 Atlanta G 30346-2117 Policy Period Effective Date Exppiration Date M-20-2388-FA65 F U 12 Months NOV 16 2016 NIM 16 2017 001788 3123 The policy period begins and ends at 12:01 am standard Addl Insured-Section II Only time atthe premisesTocation. 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 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 Reason for Declarations: Your policy is amended NOV 30 2016 ADDITIONAL INSURED ADDED FORM CMP-4859 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Sprinkler Claim Record Prepared DEC 20 2016 00, Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014636 290 Al Continued on Reverse Side of Page Page 1 of 6 N 530 s,1fl a,) 05 31 2011 11013731c! DECLARATIONS (CONTINUED) Office Policy for 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 Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 2955 VALMONT RD STE 300 No Coverage $ 80,200 25% 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) mss- Cov A - Inflation Coverage Index: N/A Cov 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. 1 s j Prepared j f DEC 20 2016 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014636 Continued on Next Page Page 2 of 6 Stale F: rn 511 ` 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 loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10000 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 i } 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 Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250.000 Coverage A - Buildings) Prepared DEC 20 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014637 290 Continued on Reverse Side of Page Page 3 of 6 N N DECLARATIONS (CONTINUED) Office Policy for CITY OF ASHLAND OREGON AND ITS Policy Number 96-BU-3823-8 CMP-4705 Loss of Income & Extra Expnse CMP-4788 Addl Insd Mgrs Lessor of Prem CMP-4785 Addl Ins Owners Lessee Blkt CMP-4786 Addl Insd Owners Lessee Sched CMP-4860 Al 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. Secretary President i ~ I i ~ I 1 I Prepared DEC 20 2016 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014638 290 Page 6 of 6 1 N ~a e1?t STATE FARM FIRE AND CASUALTY COMPANY INLAND MARINE ATTACHING DECLARATIONS A STOCK COMPANY WITH HOME OFF/' IN BLOOMlNG7-OIV, ILLINOIS 3 Ravir7 rive FPolicy Number 96-BU-3823-8 Atlanta 30346-21 17 ~Polic Period Effective Date Exp iration Date M-20-2388-FA65 F U f 12 Months NOV 16 2016 NIM 16 2017 The policy period begins and ends at 12:01 am standard Named Insured time atthe premises location. + 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 effect far 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 subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8743 Inland Marine Computer Prop FE-8739 Inland Marine Conditions , , See Reverse for Schedule Page with Limits Prepared DEC 20 2016 © Copyright, State Farm Mutual AUtOrnobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014639 530 bss dz o5 31 7011 (oIra?Uu) 96-BU-3823-8 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 2 5, 0 0 0 $ 500 Included Loss of Income and Extra Expense $ 2 5 , 0 0 0 Included 1 E { i I OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY j Prepared DEC 20 2016 C> Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. FD-6007 I 014639 1 E hall 686 a.2 U5 1 2011 10132330 I i