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HomeMy WebLinkAboutInsurance Certificate: City of Ashland - Elected Officials, Officers and Employees StateFarm STATE FARM FIRE AND CASUALTY COMPANY • A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS •~Q Fantal'6Tr9R346-2117 Policy Number 96-BU-3823-8 Policy Period Effective Date Ex !ration Data M-20-2388-FA65 F U 12 Months NOV 16 2018 NN 16 2019 004215 3123 The pot y period begins and ends at 12:01 am standard Addl Insured-Section II Only time att~ie premisesTocatlon. CITY OF ASHLAND OREGON AND ITS Named Insured ELECTED OFFICIALS, OFFICERS 8 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 - Ifthe 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/Lienholderwritten 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 $ 695.00 Discounts Applied: Renewal Year Years in Business Sprinkler Claim Record Prepared AUG 06 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 046876 290 Al Continued on Reverse Side of Page Page 1 of 6 N 580-fiefi w? 115-11-9011 Io1fA9A1r.1 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 $ '84,100 - 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) Cov A - Inflation Coverage Index: N/A Cov B - Consumer Price Index: 252.0 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. Prepared AUG 06 2018 © Copyright State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted materiel of Insurance Services Office, Inc., with its permission. 046876 Continued on Next Page Page 2 of 6 StateFann • • -e 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 $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 Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Prepared AUG 06 2018 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 046877 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-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 Of Income $5,000 Employee Dishonesty $10,000 Utility Interruption - Lass Of Income $10,000 Loss Of Income And Extra Expense Actual Loss Sustained - 12 Months Prepared AUG 06 2018 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Ino,, with its permission. 046877 Continued on Next Page Page 4 of 6 StateFarm • 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 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 CMP-4561.1 *Policy Endorsement CMP-4705.2 *Loss of Income & Extra Expnse CMP-4746.1 *Hired Auto Liability CMP-4704.1 *Dependent Prop Loss of Income CMP-4713.1 *Excl Testing Consulting E&O CMP-4703.1 *Utility Interruption Loss Incm FE-6999.2 *Terrorism Insurance Cov Notice CMP-4206.1 Amendatory Endorsement CMP-4787 Waiver of Trans Rgt of Recov CMP-4819.1 Unauthorized Business Card Use CMP-4706 Back-Up of Sewer or Drain CMP-4710 Employee Dishonesty Prepared AUG 06 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 046878 290 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-4709 Money and Securities CMP-4788 Addl Insd Mgrs Lessor of Prem CMP-4785 Addl Ins Owners Lessee Blkt CMP-4786 Addl Insd Owners Lessee Sched CMP-4860 AI Design Person Org FE-3650 Actual Cash Value Endorsement CMP-4859 Al Engineer Architect Survey 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 Prepared AUG 06 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 046878 290 Page 6 of 6 N Statefarm STATE FARM FIRE AND CASUALTY COMPANY • A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS • ® 9g 2 p e At anta 30346-2117 Policy Number 96-BU-3823-8 Policy Period Effective Date Expiration Date M-20-2388-FA65 F U 12 Months NOV 16 2018 NOV 16 2019 The pollpy period begins and ends at12:01 am standard Named Insured time atthe premiseslocanon. 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 policywill 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/Lienholderwritten 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-8743.1 'Inland Marine Computer Prop FE-8739 Inland Marine Conditions 'New Form Attached See Reverse for Schedule Page with Limits Prepared AUG 06 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 046879 530 686 a.2 05.11.2011 lot f3232c1 96-BU-3823.8 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8743.1 Inland Marine Computer Prop S 25,000 S 500 Included Loss of Income and Extra Expense S 25,000 Included OTHER LIMITS AND EXCLUSIONS MAYAPPLY- REFER TO YOUR POLICY Prepared AUG 06 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2000 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 046979 530 566.2 0531-2011 1043233.1