Loading...
HomeMy WebLinkAboutInsurance Certificate: National Research Center STATE FARM FIRE AND CASUALTY COMPANY AMENDED MAR 24 2017 A STOCK ~OMPh,NY WITH HOME OFFICES 1N BLOOMINGTON, ILLINOIS DECLARATIONS 3 Rav~ni rive Policy Number 9fi-BU-3823-8 Aflan.l~~ C.~A 30346-~ ~ 1 T Policy Period Effective Date Exppiration Date M-20-23$8-FA65 F U 12 Months NOV 16 2016 NOV 16 2017 ac~,55s s,2s The policy period be9ins and ends at 12:01 am standard Addl Insured-Section II Only time atthe premisesTocatlon. 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 975201814 Office Policy Automatic Renewal - If the policy period is shown as 12 months ,this policy will be renewed autama~cally 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 nonce in compliance with the policy provisions or as required by law. Entity: Corporation Reason for Declarations; Your policy is amended MAR 24 2017 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4786 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Sprinkler Claim Record Prepared APR 06 2017 ©Copyright, State Fari~n Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of insurance Services Office, Inc,, with its permission, 013040 290 Ai Continued on Reverse Side of Page Page 1 of 6 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 Na Coverage $ 80,200 25% BaULDER 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) www•w ~w-w•w ~ Cov A -Inflation Coverage Index: NIA 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 Qther deductibles may apply - refer to policy. i Prepared APR 06 2017 Copyright State Fanr~ Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 1 0~~04o Continued on 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 Ta Non-Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Qreakdown 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 Casts (applies only when buildings are 10% insured on a replacement cast 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 Property] Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A -Buildings) Prepared APR 06 2017 ~ Copyright, State Far~i Mutual Automobile Insurance Company, 20D8 CMP-4000 Includes copyrighted material of lnsuranee Services Office, Inc., with its permission. 013041 290 Continued an Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF ASHLAND OREGON AND ITS Policy Number 96-BU-3823-8 Ordinance Or Law -Equipment Coverage Included Outdoor Property $5,000 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 $2,500 Personal Property) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises $100,000 Off Premises $15,000 Water Damage, Other Liquids, Powder Or 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 0f Income $5,000 Employee Dishonesty $10,000 Utility Interruption - Loss Of Income $10,000 Loss 0f Income And Extra Expense Actual Loss Sustained -12 Months a Prepared APR 06 2017 Copyright, State Farm Mutual Automobile Insurance Company, 2D08 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. oi3o4~ Continued on Next Page Page 4 of 6 t i r 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 Ta Premises Rented Ta Yau $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE PraductslCompleted 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-4786 *Addl Insd Owners Lessee Schell CMP-4206.1 Amendatory Endorsement FE-6999.2 Terrorism Insurance Cov Notice CMP-4746 Nired Auto Liability CMP-4787 Waiver of Trans Rgt of Recav CMP-4713 Excl Testing Consulting EEO CMP-4819.1 Unauthorized Business Card Use CMP-4706 Back-Up of Sewer or Drain CMP-4704 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4703 Utility Interruption Lass Incur Prepared APR 06 2017 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 03042 29o Continued on 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 Loss 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 CMP-4859 AI Engineer Architect Survey FD-6007 Inland Marine Attach Dec * New Farm 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 Bloamingtan, Illinois. /~ilce~ Secretary President Prepared APR 06 2017 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ol3oaz zoo Page 6 of 6 N STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS 3 Ravini prive Policy Number 96-BU-8823.8 Atlanta ~A 30346-2117 Policy Period Effective Date Exppiration Rate M-20-23$$-FA65 F U 12 Months NOV 16 2016 NQV 16 2017 The policy period be ins end ends at 12:01 am standard Named Insured time atthe premises~ocatian. NATIONAL RESEARCH CENTER INC 2955 VALMONT RD 5TE 300 BOULDER CO 80301-1360 ATTACHING INLAND MARINE Automatic Renewal - if the policy period is shaven as 1Z months ,this policy will be renewed automatically subjectta 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. Annual Policy Pramiutn Included The above Premium Amount is included in the Policy Premium shaven 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 belovu as well as those issued subsequentto the issuance of this policy. Forms, Qptians, and Endorsements FE-8743 Inland Marine Computer Prop FE-8739 Inland Marine Conditions See Reverse far Schedule Page with Limits Prepared APR 06 2017 ~ Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013043 Sao sos ~ l 05 ~3i loi ~ ~~ii31~1~~ 96-BU-3823-8 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLANDMARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-$743 Inland Marine Computer Prop S 2 5, 0 0 0 $ 5 0 0 Include d Lass of Income and Extra Expense $ X 5, 0 0 0 Inc 1 u d e d OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY Prepared APR 06 2017 r~ Copyright, State Farm Mutual Automobile Insurance Company, 2008 ~ FD-6007 includes copyrighted material of Insurance Services Office, Inc,, with ifis permission, 013043 53~ fiN6 i~.2 qb 31 '1Q11 Io1f~i2;~3~1 i