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HomeMy WebLinkAboutInsurance Certificate: Kencairn Landscape I StateFarm STATE FARM FIRE AND CASUALTY COMPANY 1 O A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED FEB 52019 O'O® Po Box 8539251 75085-3925 Policy Number 97-E6-2275-2 Policy Period Effective Date Expiration Date M-15-12B1-FAE6 F U 12 Months OCT 29 2018 OCT 29 2019 001416 3123 The policy period begins and ends at12:01 am standard Addl Insured-Section II Only time ankle premises location. CITY OF ASHLAND Named Insured ATTN: TAMI DEMILLE-CAMPOS KENCAIRN LANDSCAPE — 20 E MAIN ST ARCHITECTURE LLC ASHLAND OR 97520-1814 545 A ST STE 3 - - ASHLAND OR 97520-2051 — Office Policy Automatic Renewal-If the policy period is shown as 12 months,this policy will be renewed automatically subject to the premiums,rules and 1 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: LLC Reason for Declarations: Your policy is amended FEB 5 2019 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4684 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Claim Record Prepared MAR 21 2019 ©Copyright State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012912 290 Al Continued on Reverse Side of Page Page 1 of 6 I N I MI a 2 05-'!19011 IT199R1�1 DECLARATIONS (CONTINUED) Office Policy for CITY OF ASHLAND Policy Number 97-E6-2275-2 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 001 545 A ST STE 3 No Coverage $ 30,700 25% ASHLAND OR 97520-2051 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 Coy 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 MAR 21 2019 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012912 Continued on Next Page Page 2 of 6 I StateFarm 0 0.0® DECLARATIONS (CONTINUED) Office Policy for CITY OF ASHLAND Policy Number 97-E6-2275-2 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 $20,000 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 MAR 21 2019 ©Copyright State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012913 290 Continued on Reverse Side of Page Page 3 of 6 I N DECLARATIONS (CONTINUED) Office Policy for CITY OF ASHLAND Policy Number 97-E6-2275-2 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 $50.000 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 - Loss Of Income $10,000 Loss Of Income And Extra Expense Actual Loss Sustained- 12 Months Prepared MAR 21 2019 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012913 Continued on Next Page Page 4 of 6 I StateFarm 0 O.O® DECLARATIONS(CONTINUED) Office Policy for CITY OF ASHLAND Policy Number 97-E6-2275-2 • 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 Excluded 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-4684 *Addl lnsd Owners Lessee Sched CMP-4237.1 Amendatory Endorsement FE-6999.2 Terrorism Insurance Coy Notice CMP-4706 Back-Up of Sewer or Drain CMP-4845 Excl Product Comp Operatn Liab CMP-4819.1 Unauthorized Business Card Use CMP-4704.1 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty .CMP-4709 Money and Securities CMP-4703.1 Utility Interruption Loss Incm CMP-4705.2 Loss of Income & Extra Expnse FE-3650 Actual Cash Vlue Endorsement Prepared MAR 21 2019 ©Copyright,State Farm Mutual Automobile Insurance Company,2000 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012914 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF ASHLAND Policy Number 97-E6-2275-2 CMP-4561.1 Policy Endorsement CMP-4527 Excl Ctrl Substances 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 MAR 21 2019 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012914 290 Page 6 of 6 N I StateFarm STATE FARM FIRE AND CASUALTY COMPANY 1 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,ILLINOIS INLAND MARINE ATTACHING DECLARATIONS OO„ PO aox 85397575085-3925 Policy Number 97-E6-2275-2 Ric ardson, Policy Period Effective Date Expiration Date M-15-12B1-FAE6 F U 12 Months OCT 29 2018 OCT 29 2019 The policy period begins and ends at12:01 am standard Named Insured time atttle premises Tocaton. KENCAIRN LANDSCAPE ARCHITECTURE LLC 545 A ST STE 3 ASHLAND OR 97520-2051 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/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-8739 Inland Marine Conditions FE-6867 Amend of Inland Marine Condtns FE-8743.1 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared MAR 21 2019 ©Copyright State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012915 530-6136 a.205-31-2011(ol3232c) I 97-E6-2275-2 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 $ 25 , 000 $ 500 Included Loss of Income and Extra Expense $ 25 , 000 Include d OTHER LIMITS AND EXCLUSIONS MAY APPLY- REFER TO YOUR POLICY Prepared MAR 21 2019 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012915 530.606 a.2 05-31 2011(o1f3233c) I StateFarm 0 97-E6-2275-2 012916 CMP-4664 00, Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ( CMP-4684 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS $,, (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 97-E6-2275-2 Named Insured: KENCAIRN LANDSCAPE ARCHITECTURE LLC 545 A ST STE 3 ASHLAND OR 97520-2051 Name And Address Of Additional Insured Person Or Organization: CITY OF ASHLAND ATTN: TAMI DEMILLE-CAMPOS 20 E MAIN ST ASHLAND OR 97520-1850 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to include, as an additional insured, any person or organization shown in the Schedule, but only: a. Ongoing Operations With respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused by your ongoing operations for that additional insured and only to the extent that such "bodily injury", "property damage' or"personal and advertising injury" is caused by your negligence or the negligence of those performing operations on your behalf; or b. Products-Completed Operations To the extent that the liability for"bodily injury" or"property damage" is caused by "your work" per- formed for that additional insured and Included in the "products-completed operations hazard". 2. Any insurance provided to the additional insured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insurance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provid- ed by you. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. CMP-4684 O,Copyright,State Farm Mutual Automobile Insurance Company,2011 Includes copyrighted material of Insurance Services Office, Inc., with its permission.