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HomeMy WebLinkAboutInsurance Certificate: Better View StateFarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED AUG 30 2018 CAD 88 225 Po Box 85 925k 75085-3925 Policy Number 97-E6-2511-4 Policy Period Effective Date Expiration Date M-15-2134-FAE6 F N 12 Months JUN 27 2018 JUN 27 2019 001859 3123 The policy period begins and ends at 12:01 am standard Addl Insured-Section II Only time atthe premises location. CITY OF ASHLAND Named Insured 20 E MAIN ST BETTER VIEW LLC ASHLAND OR 97520-1814 DBA FARRELL'S GLASS SERVICE PO BOX 849 — MEDFORD OR 97501-0061 Auto Services Policy Automatic Renewal - If the policy period is shown as 12 months,this policy will be renewed automatically subject to 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: Limited Liability Company Reason for Declarations: Your policy is amended AUG 30 2018 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4684 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Protective Devices Claim Record Prepared SEP 05 2018 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 019750 290 Al Continued on Reverse Side of Page Page 1 of 6 N DECLARATIONS(CONTINUED) Auto Services Policy for CITY OF ASHLAND Policy Number 97-E6-2511-4 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) 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 $20,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $5,000 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 Employee Dishonesty $10,000 Loss Of Income And Extra Expense Actual Loss Sustained - 12 Months Prepared SEP 05 2018 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 019751 Continued on Next Page Page 4 of 6 • StateFarm 0 CYO DECLARATIONS (CONTINUED) Auto Services Policy for CITY OF ASHLAND Policy Number 97-E6-2511-4 SECTION II - DEDUCTIBLES Business Liability - Property Damage $250 Other deductibles may apply - refer to policy. SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $2,000,000 General Aggregate $2,000,000 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 CMP-4412 Operation of Customers Auto CMP-4827.1 Employee Tool Coverage FE-6999.2 Terrorism Insurance Coy Notice CMP-4237.1 Amendatory Endorsement Prepared SEP 05 2018 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 019752 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Auto Services Policy for CITY OF ASHLAND Policy Number 97-E6-2511-4 CMP-4705.2 Loss of Income & Extra Expnse CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4744 Garagekeepers Direct Coverage CMP-4706 Back-Up of Sewer or Drain CMP-4683 Addl Ins Owners Lessee Blkt CMP-4788 Addl Insd Mgrs Lessor of Prem FE-3650 Actual Cash Vlue Endorsement CMP-4742.1 Garage Liability CMP-4561.1 Policy Endorsement CMP-4527 Excl Ctrl Substances CMP-4860 Al Design Person Org 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. M 1/0,4e1LE, "e-4-4,7777 Secretary President Prepared SEP 05 2018 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 019752 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 Po Box 8539255 Policy Number 97-E6-2511-4 Richardson, x 75085-3925 Policy Period Effective Date Expiration Date M-15-2134-FAE6 F N 12 Months JUN 27 2018 JUN 27 2019 The policy period begins and ends at 12:01 am standard Named Insured time atthe premises location. BETTER VIEW LLC DBA FARRELL'S GLASS SERVICE PO BOX 849 MEDFORD OR 97501-0061 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 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. 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 SEP 05 2018 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 019753 530-660 a.2 05 31 2011(0113232c) 97-E6-2511-4 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 2 5 , 0 0 0 $ 5 0 0 Included Loss of Income and Extra Expense S 25, 0 0 0 Included OTHER LIMITS AND EXCLUSIONS MAY APPLY- REFER TO YOUR POLICY Prepared SEP 05 2018 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 019753 530 686 0.2 05 31 2011 101132330