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HomeMy WebLinkAboutInsurance certificate: Wildrivers Surveying LLC StateFarm STATE FARM FIRE AND CASUALTY COMPANY ❑ A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,ILLINOIS DECLARATIONS AMENDED JUN 302019 Pochard8on9TX 75085-3925 Policy Number 97-B8-B119-3 Addl Insured-Section II Only Policy Period Effective Date Expiration Date M-15-2339-FAE6 F N 12 Months JAN 24 2019 JAN 24 2020 001408 3123 The polipy period begins and ends at12:01 am standard m THE ASHLAND CITY COUNCIL time ante premises location. 20 E MAIN ST ASHLAND OR 97520-1814 Named Insured WILD RIVERS SURVEYING LLC 3339 GREEN ACRES DR 'I11����'Ii'I' '�I'll�l��ll�l�lllnlllld[ll�l'Ill'�'I�I��'��"'I CENTRAL POINT OR 97502-1413 S Fo w b Businessowners 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 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: Limited Liability Company Reason for Declarations: Your policy is amended JUN 30 2019 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT , FORM CMP-4684 ADDED Endorsement Premium Increase $ 165.00 Prepared AUG 06 2019 ©Copyright State Farm Mutual Automobile Insurance Company,2009 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012565 290 Al Continued on Reverse Side of Page Page 1 of 6 530E05 w 2 0531223'1 101137310 DECLARATIONS(CONTINUED) Businessowners Policy for THE ASHLAND CITY COUNCIL Policy Number 97-B8-B119-3 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 3339 GREEN ACRES DR No Coverage $ 26,200 25% CENTRAL POINT OR 97502-1413 *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) Coy A- Inflation Coverage Index: N/A Coy B - Consumer Price Index: 252.4 SECTION I- DEDUCTIBLES - Basic Deductible $500 Special Deductibles: Money and Securities $250 Equipment Breakdown $500 Other deductibles may apply- refer to-policy. Prepared AUG 06 2019 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012565 Continued on Next Page Page 2 of 6 StateFarm ❑ 0 o'O® DECLARATIONS(CONTINUED) Businessowners Policy for THE ASHLAND CITY COUNCIL Policy Number 97-B8-B119-3 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE- EACH DESCRIBED PREMISES 8 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, ILE but has"Included" indicated, please refer to that policy provision for an explanation of that coverage. No LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $10,000 Off Premises $5,000 Arson Reward $5,000 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 $2,500 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) $2,000 Money And Securities (On Premises) $5,000 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 2019 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012566 290 Continued on Reverse Side of Page Page 3 of 6 N II_ DECLARATIONS (CONTINUED) Businessowners Policy for THE ASHLAND CITY COUNCIL Policy Number 97-B8-B119-3 Ordinance Or Law- Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $2,500 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 Valuable Papers And Records On Premises $10,000 Off Premises $5,000 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 Loss Of Income And Extra Expense Actual Loss Sustained- 12 Months SECTION II- LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L- Business Liability $2,000,000 Prepared AUG 06 2019 ©Copyright.State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012566 Continued on Next Page Page 4 of 6 StateFarm ❑ o®® DECLARATIONS(CONTINUED) Businessowners Policy for THE ASHLAND CITY COUNCIL Policy Number 97-B8-B119-3 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-4684 'Addl Insd Owners Lessee Sched FE-6999.2 Terrorism Insurance Coy Notice CMP-4237.1 Amendatory Endorsement CMP-4705.2 Loss of Income & Extra Expnse CMP-4709 Money and Securities FE-3650 Actual Cash Vlue Endorsement CMP-4561.1 Policy Endorsement CMP-4527 Excl Ctrl Substances FD-6007 Inland Marine Attach Dec ' New Form Attached Prepared AUG 06 2019 ©Copyright State Farm Mutual Automobile Insurance Company,2000 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012567 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS(CONTINUED) . Businessowners Policy for THE ASHLAND CITY COUNCIL Policy Number 97-B8-B119-3 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 AUG 06 2019 ©Copyright.State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012567 290 Page 6 of 6 N StateFarm STATE FARM FIRE AND CASUALTY COMPANY O A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,ILLINOIS INLAND MARINE ATTACHING DECLARATIONS-' O'O o pc ox 853925 Richardson, TX 75085-3925 Policy Number 97-68-8719-3 Named Insured Policy Period Effective Date Expiration Date M-15-2339-FAE6 F N 12 Months JAN 24 2019 JAN 24 2020 The policy period begins and ends at12:01 am standard WILD RIVERS SURVEYING LLC time at the premisesTocatton. 3339 GREEN ACRES DR CENTRAL POINT OR 97502-1413 • S th y80 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 Amountis 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 AUG 06 2019 ©Copyright,State Farm Mutual Automobile Insurance Company,2009 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012568 530-fin a.2 25362011 1o113232c1 97-B8-B119-3 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 Included • OTHER LIMITS AND EXCLUSIONS MAY APPLY-REFER TO YOUR POLICY Prepared AUG 06 2019 ®Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012568 53a-6136 a.2 a5-31-2a11 1u1f3233c1 StateFarm 97-B8-B119-3 012569 CMP-4684 U ® 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: .w.. �» BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 97-B8-B119-3 yo Named Insured: WILD RIVERS SURVEYING LLC 3339 GREEN ACRES DR CENTRAL POINT OR 97502-1413 Name And Address Of Additional Insured Person Or Organization: THE ASHLAND CITY COUNCIL 20 E MAIN ST ASHLAND OR 97520-1849 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 ©,Copyright,State Farm Mutual Automobile Insurance Company,2011 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.