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HomeMy WebLinkAboutInsurance Certificate: Wild Rivers Surveying LLC (3) State Farm at Cityl-ine PO Box 853925 • W StateFarw Richardson, TX 75085.3925 000057 1200 AT1 State Farm Fire and Casualty Company THE ASHLAND CITY COUNCIL A stock company with home offices in Bloomington, Illinois ~f 20 E MAIN ST ASHLAND OR 97520-1814 s 0 ~g rllll'III'lllllllllll'lll'11111'lllllllllllllllllllllllllllllllll ~o Renewal Declarations Policy number: 97-CN-X256-3 Effective date: January 24, 2020 Policy period: 12 months Expiration date: January 24, 2021 The policy period begins and ends at 12:01 am standard time at the premises location. :IlL'a5~1.r.;Pi S P 0 L 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 MortgageelLienholder written notice in compliance with the policy provisions or as required by law. WILD RIVERS SURVEYING LLC 3339 GREEN ACRES DR CENTRAL POINT OR 97502-1413 ENTITY Limited Liability Company Ifr1PORTANT MESSAGE(S) Notice - Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIIIM 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: $325.00 Minimum Premium Discounts applied: Business Experience Rating Renewal Discount Business in Residence Premises Policy Number: 97-CN-X256-3 Page 1 or 5 Prepared: November 16, 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP Dec 3P OR 1009482 2001 153090 201 03-06-2011 CMP•4000 000313 I c:O). ate Farm SECTION I PROPERTY SCHEDULE 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 3339 GREEN ACRES DR No Coverage $26,700 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 - INFLATI"-) N COVERAGE INDEX(ES) Cov A - Inflation Coverage Index: N/A Cov B - Consumer Price Index: 256.8 SECTION i - DEDUCTIBLES BASIC DEDUCTIBLE $500 SPECIAL DEDUCTIBLES: Equipment Breakdown: $500 Money and Securities: $250 Other deductibles may apply - refer to policy. SECTION ! - EXTE.NS:ONS 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, 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-CN-X256-3 Page 2 of 5 Prepared. November 16, 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 I I Ih ❑ kateFarrp Coverage Limit of Insurance Money Orders and Counterfeit Money $1,000 Money and Securities On Premises $5,000 ° ° 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 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. Coverage Limit of Insurance Loss of Income and Extra Expense 12 Months Actual Loss Sustained SECTION 11 - LOCATION SCHEDL Location Location of described premises number 001 3339 GREEN ACRES DR CENTRAL POINT OR 97502-1413 cE:CTION II - LIAHit-i Coverage Limit of Insurance Coverage L - Business Liability Per Occurrence $2,000,000 Policy Number 97-CN-X256-3 Page 3 of 5 Prepared. November 16 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP 4000 OOD314 t s~ Ulte Farm Coverage Limit of Insurance Coverage M - Medical Expenses $10,000 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 BUSI NESSOWNERS 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. '"'1.1` AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form CMP-4237.1 Amendatory Endorsement (Oregon) CMP-4527 Marijuana Exclusion CMP-4561.1 Policy Endorsement * CMP-4683.1 Additional Insured - Owners, Lessees or Contractors (Blanket) * CMP-4684.1 Additional Insured - Owners, Lessees or Contractors (Scheduled) * CMP-4705.2 Loss of Income and Extra Expense CMP-4709 Money and Securities FD-6007 Inland Marine Attaching Declarations FE-3650 Actual Cash Value Endorsement FE-6999.2 Policyholder Disclosure Notice of Terrorism Insurance Coverage *New Form Attached This policy is issued by the State Farm Fire and Casualty Company. •RTICIPATING POL. CY 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. President Secretary °)Iicy Number: 97-CN-X256-3 Page 4 of 5 Prepared: November 16, 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 i AStateFarm NOTICE TO POLICYHOLDER: For a comprehensive description of coverage and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. 0 Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your ° policy, Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. Your coverage amount.... It is up to you to choose the coverage and limits that meet your needs. We recommend that you purchase a coverage limit equal to the estimated replacement cost of your structure. Replacement cost estimates are available from building contractors and replacement cost appraisers, or, your agent can provide an estimate from Xactware, Inc. using information you provide about your structure, State Farm does not guarantee that any estimate will be the actual future cost to rebuild your structure. Higher limits are available at higher premiums. Lower limits are also available, as long as the amount of coverage meets our underwriting requirements. We encourage you to periodically review your coverages and limits with your agent and to notify us of any changes or additions to your structure. Policy Number 97-CN-X256-3 Page 5 of 5 Prepared: November 16, 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 --MP-400D I J State Farm at Cityl-ine PO Box 853925 Richardson, TX 75085-3925 • w StateFarm State Farm Fire and Casualty Company THE ASHLAND CITY COUNCIL A stock company with home offices in Bloomington, Illinois ti 20 E MAIN ST 4 ASHLAND OR 97520-1814 8 0 0 ~a ~o Inland Marine Attaching Declarations Policy number: 97-CN-X256-3 Effective date: January 24, 2020 Policy period: 12 months Expiration date: January 24, 2021 The policy period begins and ends at 12:01 am standard time at the premises location. ;,THING 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. IONS AND _iVNENT : 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 ATTACHING INLAND NIARINE 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-CN-X256-3 Page 1 of 1 Prepared. November 16, 2019 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CIM Att Dec 3P OR 1009481 2001 153089 201 12-04-2018 FD-6007 000316