Loading...
HomeMy WebLinkAboutInsurance Certificate: Boiler Works Jrarerarm a I A l C rmrsm rinc Arvu uAauRL I I cvnnr•Ary r AMENDED JAN 2 2022 LJ A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON ILLINOIS. DECLARATIONS ovc,® Pp Box 853925_ Policy Number ,97-CM-N878-7 Ric ardson, 75085-3925 a Addl Insured-Section ll Only • Policy Period Effective Date Expiration Date M-15-2275-FAE6 F E 1 Year JAN 2 2022 JAN 2 2023 001161 3123 The policy period begins and ends at 12:01 am standard THE CITY OF ASHLAND, OREGON time atthe premises-Location. ITS OFFICERS, -AGENTS AND n• + EMPLOYEES 90 N MOUNTAIN AVE • Named Insured 11•- • ASHLAND OR 97520-2014 ROGUE BOILER WORKS LLC 1llII1I dlidlin.iil.l1I.ihI'Illi'II'iiIilllilll.hiiiiIiiiiIi 8 0 MO Artisan And Service Contractor Policy r 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/Lienhoider Written notice in compliance with the policy provisions or as required by law. , Entity: Limited Liability Company Reason for Declarations: Your policy is amended JAN 2 2022 . ADDITIONAL INSURED ADDED _ PREMIUM•ADJUSTMENT:. . FORM CMP-4684.1 ADDED , Endorsement Premium None . r . "' • ,Audit Period:Annual ' Discounts Applied: • ' ,r ' Renewal,Year , Years in Business Claim Record Prepared NOV 09 2021 ©Copyright,State.Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR - Includes copyrighted material'oflniurance Services'Office,'Inc.,with its permission. , - 009057 290 Al Continued on'Reverse Side of Page Page 1 of' 6 N - . . DECLARATIONS(CONTINUED) " Artisan And Service Contractor`Po`licy for THE CITY OF ASHLAND,OREGON . - • Policy Number 97-CM-N878-7., R • p • - s "`• 1• 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.Per'sonal- Personal a; Property. Property • 001 -2105 COREY RD No-Coverage _ - ` $ 79,000 - -25% CENTRAL POINT OR 97502-9405 j *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) t. Coy A- Inflation Coverage Index: . N/A Coy B -'Consumer Price Index: 274.3 SECTION I- DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Equipment Breakdown , • $1,000 • Other deductibles,may apply-refer,to policy. • • Prepared NOV 09 2021 ©Copyright,State;Farm Mutual Automobile Insurance,Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc ,with its permission. 009057 Continued on Next Page. , Page. 2.of 6 brarerarm L i o® DECLARATIONS1CONTINUED) Artisan And Service Contractor Policy`for THE'CITY OF ASHLAND,'OREGON ' Policy Number 97-CM-N878-7: ' SECTION I- EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE EACH DESCRIBED,PREMISES, g The coverages and corresponding limits shown below apply separately to each described premises shown in these g Declarations, unless indicated by"See Schedule." If a coverage does not have a corresponding limit shown below, but has"Included" indicated, please refer•to.that policy,,.provision,for an explanation of that.^coverages ; . ; LIMIT'OF COVERAGE INSURANCE Accounts Receivable rOn Premises „,' :$10,000 Off,Premises $5,000 Arson Reward •. . z,• •$5,000 Collapse Included Damage To Non-Owned Buildings From Theft, Burglary Or Robbery • Coverage B Limit Debris Removal 25%of:coveredJoss: •, Equipment Breakdown Included Fire Department Service Charge • r,, $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 ; • . . 1.0% • insured on a replacement cost basis) • 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 • Prepared NOV 09 2021 ©Copyright,State Farm Mutual Automohile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of In'suranc'e Services Office;fhb.,with its permission. 009058-290, Continued'on'Reverse Side of Page Page 3-'of 6 DECLARATIONS,(CONTINUED) •• Artisan And Service Contractor Policy'+for THE;.CITY,OF ASHLAND,OREGON., Policy,Number 97-CM-N878-7 "'" • ° Personal Effects (applies only to those premises provided Coverage B-Business $2,500 Personal Property) Personal Property Off Premises $15,000 =• Pollutant Clean UpAnd Removal ' = $10,000 Preservation Of Property ;` - • ' .. • 30 Days Property Of Others(applies'only those premises provided Coverage B - Busiiness $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 . ' - -'' In'cl'uded SECTION li-DEDUCTIBLES Business Liability- Property Damage $500 Other deductibles may apply- refer to policy. ', SECTION II LIABILITY ' • • LIMIT OF COVERAGE INSURANCE Coverage L- Business Liabilit • 9 Y ,$2',OQ0,000 Coverage M - Medical Expenses (Any One Person) $10,000 Damage,To Premises Rented To You ' ,; $100,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate • • $4,000,000 Prepared NOV 09 2021 , ©Copyright,State Farm Mutual Automobile Insurance Company,2008 - CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. ;;. 009058 „Continuedon Next Page Page 4 of 6 3rarerarm u o o-o® DECLARATIONS(CONTINUED) Artisan And Service Contractor Policy for THE CITY'OF ASHLAND, OREGON =i'"' ' ; - Policy Number 97-CM-N878-7 General Aggregate $4,000,000 Each paid claim for LiabilityCoverage reduces the amount of insurance.`we rovide,durin thew applicable.' annual period. Please refeto Section II.- Liability in the Coverage.Form and any attached endorsements. mo N 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 wellas those issued subsequent to•the issuance of this policy. `' ... FORMS AND ENDORSEMENTS CMP-41 00 Businessowners Coverage Form CMP-4684.1 *Addl lnsd Owners Lessee Sched CMP-4600 Artisan and Service Contractor FE-6999.3 Terrorism Insurance Cov Notice, CMP-4237.1 Amendatory'Endorsement FE-3650 Actual Cash Value Endorsement CMP-4561.1 Policy Endorsement CMP-4683.1 Addl Ins Owners Lessee Blkt . CMP-4787 Waiver of Trans Rgt of Recov CMP-4527 Excl Ctrl Substances CMP-4875 Loss Payable FD-6007 . Inland Marine Attach Dec * New Form.Attached Prepared NOV 09 2021 ©Copyright;State Farm Mutual Automobile Insurance,Company,2008 • CMP-4000 OR Includes copyrighted material of Insurance Services Office;Inc.,With its permission.. • 009059`.290 Continued on Reverse Side of Page Page 5 of 6 DECLARATIONS(CONTINUED). Artisan.And Service Contractor Policy for THE CITY,OF ASHLAND,OREGON ., , .. Policy Number 9T-CM-N878-7 • "at 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 accordancewith 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 .. .. , .. .... — .— .. a r.,. •F. Prepared NOV 09 2021 ©Copyright,State Farm Mutual Automobile Insurance:.Company,2008 CMP-4000 OR. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. " 009059 290 Page 6 of 6 • N slratetarm STATE FARM FIRE AND CASUALTY COMPANY °' 0 A STOCK COMPANY WITH HOME,OFFICES-IN BLOOMINGTON,;ILLINOIS .INLAND.MARINE ATTACHING DECLARATION, Po Sox 853925 PolicyNumber 97-CM-N878-7 Richardson, TX 75085-3925' Named Insured Policy.Period Effective Date Expiration Date: M-15-2275-FAE6 F E 1 Year JAN 2 2022 JAN 2 2023 The policy period'begins''and ends at 12:01 am standard ROGUE BOILER WORKS LLC time.athe.premises location. mir . o ATTACHING INLAND MARINE Automatic Renewal-If'the policy period'is shown as 12 months,.this policy will be'renewed automaticallysubjectto the premiums,rules and forms in effect for each succeeding policy period.Hillis policy is terminated,we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions oras required by law.' Annual Policy Premium The above Premium Amount is included in the.Policy Premium shown on the Declarations. • . Your policy consists"of these Declarations,the INLAND MARINE CONDITIONSshown 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 FE-8756.1 Installation Endorsement FE-8760 Mobile Equipment Form • See Reverse for Schedule Page with Limits • Prepared NOV 09 2021 ®Copyright.State Farm Mutual Automobile Insurance 'Company,2008 FD-6007 Includes copyrighted material of Insurance'Services•Office,Inc.,with its permission. . 009060; ATTACHING INLAND MARINE SCHEDULE PAGE 1 ,.r 4, ATTACHING INLAND.MARINE ENDORSEMENT LIMIT OF . DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE ' AMOUNT PREMIUM' FE-8743.1 Inland Marine Computer Prop ' . $ .25,000 . $ 500 . Included FE-8760. Mobile Equippment. Form $ 20 ,000 $ 500 . .$ ' 1.0 0 .-0, FE-8756.1 Installation Endorsement $ 5,000 .. S. 50'0 Included Property in Transit $ 5,000 ^:. R Number.of Job-Sites:- • • • • OTHER LIMITS AND EXCLUSIONS`MAYAPPLY-REFER TO YOUR POLICY Prepared 1 ' NOV 09 2021 .®Copyright,State Farm Mutual Automobile Insurance: Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc with its permission. • 009060 536-666 8.2'65.31-2011 1o1f323'