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HomeMy WebLinkAboutInsurance Certificate: Cathey Shea StateFarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS Po Box 8539K rc Policy Number 97-CL-U609-5 8539? 75085-3925 R Addl Insured-Section II Only Policy Period Effective Date Expiration Date M-15-0908-FAE6 F N 12 Months SEP 1 2019 SEP 1 2020 001858 3123 The poli y period beggins and ends at 12:01 am standard CITY OF ASHLAND time att~ie premises Tocatlon. 20 E MAIN ST ASHLAND OR 97520-1814 Named Insured CATHEY, SHEA 826 B ST I~IIII'II.I~I"II~III~I~~~~IIIII~I~I~'lllllll~~l'I~I'I~...I"1111 ASHLAND OR 97520-2030 ~o 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 effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienhold er written notice in compliance with the policy provisions or as required by law. Entity: Individual POLICY PREMIUM $ 465.00 Minimum Premium Prepared SEP 11 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015927 290 Al Continued on Reverse Side of Page Page 1 of 6 N DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF ASHLAND Policy Number 97-CL-U609-5 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 1699 HOMES AVE No Coverage $ 5,000 25% ASHLAND OR 97520-2301 " 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: 256.6 SECTION I - DEDUCTIBLES Basic Deductible $500 Special Deductibles: Money and Securities $250 Equipment Breakdown $500 Other deductibles may apply - refer to policy. Prepared SEP 11 2019 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015927 Continued on Next Page Page 2 of 6 StateFarr = • DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF ASHLAND Policy Number 97-CL-U609-5 M SECTION 1- EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES s 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, ~o but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COV. Accounts Receivable On Premises J-- 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 SEP 11 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015928 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF ASHLAND Policy Number 97-CL-U609-5 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 1 - 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 11- LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Prepared SEP 11 2019 © Copyright, State Farm Mutual Automobile Insurance Company, Zoos CMP-4000 OR Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015928 Continued on Next Page Page 4 of 6 StateFarm • • • DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF ASHLAND Policy Number 97-CL-U609-5 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE s 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-4237.1 Amendatory Endorsement CMP-4561.1 Policy Endorsement CMP-4705.2 Loss of Income & Extra Expnse FE-3650 Actual Cash Vlue Endorsement CMP-4709 Money and Securities CMP-4527 Excl Ctrl Substances FE-6999.2 Terrorism Insurance Cov Notice CMP-4788 Addl Insd Mgrs Lessor of Prem FD-6007 Inland Marine Attach Dec Prepared SEP 11 2019 t% Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015929 290 Continued on Reverse Side of Page Page 5 of 6 N I DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF ASHLAND Policy Number 97-CL-U609-5 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 SEP 11 2019 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015929 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 R' hards8on9TX 75085-3925 Policy Number 97-CL-U609-5 Named Insured Policy Period Effective Date Expiration Date M-15-090B-FAE6 F N 12 Months SEP 1 2019 SEP 1 2020 The poll y period begins and ends at 12:01 am standard CATHEY, SHEA time att a premises location. 826 B ST ASHLAND OR 97520-2030 8 0 Cn a Cn o 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 effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lien holder written notice in 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 FE-6867 Amend of Inland Marine Condtns See Reverse for Schedule Page with Limits Prepared SEP 11 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015930 Io113232:~ 530 686 a.2 05 31 2011 97-CL-U609-5 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 5 500 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 11 2019 (D Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015930 530 686 a.2 65 31-2011 lotf3233c) State Farm 97-CL-U609-5 015931 CMP-4788 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4788 ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE n Policy Number: 97-CL-U609-5 n Named Insured: CATHEY SHEA 826 B SY ASHLAND OR 97520-2030 Name And Address Of Additional Insured Person Or Organization: CITY OF ASHLAND 20 E MAIN ST ASHLAND OR 97520-1850 Location Of Premises (Part Leased To You): 1699 HOMES AVE ASHLAND OR 97520-2301 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 with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule. 2. With respect to the insurance afforded the additional insured, this insurance does not apply to a. Any "occurrence" or offense which takes place after you cease to be a tenant in the premises shown in the Schedule. b. Structural alterations, new construction or demolition operations performed by or for that addi- tional insured. 3. 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. 4. 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. All other policy provisions apply. CMP-4788 Copyright State Farm Mutual Automobile Insurance Company. 2008 Includes copyrighted material of Insurance Services Office. Inc_ with its permission