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HomeMy WebLinkAboutInsurance Certificate: Emerging Futures Youth Network State Farm at Cityl-ine Ll PO Box 853925 Richardson, TX 75085-3925 ^ StateFarw 000207 1200 AT1 State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 20 E MAIN ST ASHLAND OR 97520-1814 S 0 CO o ~11~1~11~1~~~1~~1~~J111J~1~~111111~111~~111~~~~~11~~~~11~1~~1~1~ Declarations Policy number: 97-CK-S482-9 Effective date: October 16, 2019 Policy period: 12 months Expiration date: October 16, 2020 The policy period begins and ends at 12:01 am standard time at the premises location. aAESS 14'tiEt 0 PC?LICY Automatic renewal - If the State Farm° 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. NAME D1. NSU RED EMERGING FUTURES YOUTH NETWORK 1180 PARK ST ASHLAND OR 97520-3535 JITY Nonprofit ;t-;CY PREMIUM This is not a bill. If an amount is due, then a separate statement will be sent prior to the due date. The premium(s) shown below is the 12 months premium(s) for the characteristics of the policy as described in this Declarations, Total Premium: $465.00 Minimum Premium Discounts applied: Business Experience Rating Protective Devices Improvements and Betterments Policy Number: 97-CK-S482-9 Page 1 of 4 Prepared: November 13, 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP Dec 3P OR 1009482 2001 153090 201 03-06-2019 CMP-4000 001039 I k:r.. I st.~'b ! I~ISLJI'~iY1 ~ ~'.I~L:}lll_t~ Location Location of described premises Limit of Insurance- Limit of Insurance* Seasonal increase - number Coverage A - Coverage B - Business Business Personal Property Building Personal Property 001 1180 Park St No Coverage $1,000 25% Ashland OR 97520-3535 As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. E ,tl0NN (OVERAGE INDEX(ES) Cov A - Inflation Coverage Index: N/A Cov B - Consumer Price Index: 256.8 ~i sED ~wtt ' BASIC DEDUCTIBLE $1,000 SPECIAL DEDUCTIBLES: Equipment Breakdown: $1,000 Money and Securities: $250 Other deductibles may apply - refer to policy. SECTION a - -XTENSIONS OF COVERAGE LIMIT OF !NSURANC E - EA ,H DF- C ruE: r) 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, refer to that policy provision for an explanation of that coverage. Coverage Limit of 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 insured on a 10% replacement cost basis) Policy Number: 97-CK-S482-9 Page 2 of 4 Prepared November 13, 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Coverage Limit of Insurance Money Orders and Counterfeit Money $1,000 Money and Securities On Premises $5,000 0 0 Off Premises $2,000 Newly Acquired Business Personal Property (applies only if this policy provides Coverage B - Business $100,000 Personal Property) Newly Acquired or Constructed Buildings (applies only if this policy provides Coverage A - Buildings) $250,000 Ordinance or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) $2,500 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 Personal Property) $2,500 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 C'HON I - EXTENSIONS OF COVEIaAa'F - f',,''3URA J:'1.E - PE R 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. Coverage Limit of Insurance Loss of Income and Extra Expense 12 Months Actual Loss Sustained )N II - L OC".TiON SCHEDULE Location Location of described premises number 001 1180 Park St Ashland OR 97520-3535 7 Coverage Limit of Insurance Coverage L - Business Liability Per Occurrence $2,000,000 Policy Number. 97-CK-S482-9 Page 3 of 4 Prepared. November 13, 2019 0 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 001040 Coverage Limit of Insurance Coverage M - Medical Expenses $5,000 Any One Person Damage to Premises Rented to You $300,000 Aggregate Limits Limit of 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. N' (14? : r ENTS CMP-4100 Businessowners Coverage Form CMP-4237.1 Amendatory Endorsement (Oregon) CMP-4527 Marijuana Exclusion CMP-4561.1 Policy Endorsement CMP-4705.2 Loss of Income and Extra Expense CMP-4709 Money and Securities CMP-4787 Waiver of Transfer of Rights of Recovery Against Others To Us CMP-4788 Additional Insured - Managers or Lessors of Premises FD-6007 Inland Marine Attaching Declarations FE-3650 Actual Cash Value Endorsement FE-6999.2 Policyholder Disclosure Notice of Terrorism Insurance Coverage This policy is issued by the State Farm Fire and Casualty Company. 'ARTICCI oATJN( P )Lif__ Y 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. President Secretary i~ Policy Number: 97-CK-S482-9 Page 4 of 4 Prepared, November 13. 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 State Farm at CityLlne PO Box 853925 Richardson. TX 75085-3925 et:°ci j 2rC State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 20 E MAIN ST ASHLAND OR 97520-1814 8 0 0 0 ~o Inland Marine Attaching Declarations Policy number: 97-CK-S482-9 Effective date: October 16, 2019 Policy period: 12 months Expiration date: October 16, 2020 The policy period begins and ends at 12.01 am standard time at the premises location. ATTACHING INLAND MARINE Automatic renewal - If the State Farm° 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, 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 subsequent to the issuance of this policy. PT IONS AN N E N-1 FE-6867 Inland Marine Amendment of Inland Marine Conditions FE-8739 Inland Marine Conditions FE-8743.1 Inland Marine Computer Property Form See below for schedule page with limits AT-gACHING INLAND MARINE_ SCHEDULE PAGE Endorsement Coverage Limit of insurance Deductible amount Annual premium number FE-8743.1 Inland Marine Computer Property Form $25,000 $500 Included Loss of Income and Extra Expense $25,000 Included Other limits and exclusions may apply - refer to your policy. Policy Number. 97-CK-S482-9 Page 1 of 1 Prepared November 13, 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CIM Att Dec 3P OR 1009481 2001 153089 201 12-04.2018 FD-6007 001041