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HomeMy WebLinkAboutAmendend Insurance Certificate: Maneker, Jeremy OLQ rami IILWUIilIWtl — 2 PO Box o - CSO State Farmer .Bloomington,:!L.,61702-2915 AT2 002005 1200 01 State:Farmfire,and.Casualty,Company CITY OF ASHLAND THE CITY OF AS A stock company with home offices in Bloomington, Illinois Nil 20EMAINST - .ASHLAND OR-97520-1814 `' ,, S . 0 liili1lll1ilnrllll'lil1lll1illi1'I'I1'III1Il!ll�ll11ll�lilnllli ' �o , • Amended Declarations - ". ' . . . . - . . , Policy number:97-CR-B526-0 Effective date:January 18, 2022 Policy period: 12 months • Expiration date:September 9, 2022 The policy period begins and ends at 12:01 am standard time;at the premises location. - • AUTO SERVICES POLICY . - ' Automatic renewal -If the State Farm®'policy,period•is,shown',;as 12Amonths„this.policy will;be renewed:.automatically-subject to:the premiums, rules and forms in effect for each.succeeding policy period. If thispolicy is terminated,,we will.give you and the__:_. . _ _ . __ Mortgagee/Lienholder:written notice-in compliance-with the policy provisions or as required by law. - . NAMED INSURED = ' JEREMY MANEKER . ENTITY Sole Proprietorship-Individual . • REASONS FOR DECLARATIONS 0. Your policy is amended effective January 18, 2022 due to some recent policy changes you requested. Enclosed is a copy of,your new endorsements, if any. - 0 POLICY 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 are for the policy period and policy characteristics as described.in this Declarations: Increase in premium: $8.00 Discounts applied: • - Business Experience Rating Protective Devices _, _ Years in Business , Policy number:97-CR-B526-0 Page 1 of 5 Prepared:January 20,2022 ©Copyright,State Farm Mutual Automobile Insurance Company, 2008 ' ' GMP Dec 3P OR.1 CMP-4000 1009482 2005 153090 205 08-21-2021 008364 - ' •o o SfateFarme 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 Buildings Personal Property 001 2001 NE Foothill Blvd Ste E4 No Coverage $206,200 25% Grants Pass OR 97526-4240 *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) Coy A-Inflation Coverage Index: N/A Coy B-Consumer Price Index: 267:1 SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE $1,000 SPECIAL DEDUCTIBLES: Employee Dishonesty: $250 Equipment Breakdown: • $1.,000 • Garagekeepers-Collision: $500 ' Garagekeepers-Comprehensive: $250 Money and Securities: $250 Other deductibles may apply-refer to policy. SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-EACH DESCRIBED PREMISES • The coverages and'corresponding limits'shownrbelow apply'separately'to each described premises shown in these Declarations, unless indicated by"See schedule". If a coverage does riot 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 Back-up of Sewer or.Drain $15,000 Collapse Included Damage to Non-owned Buildings from Theft,Burglary or Robbery Coverage B Limit Debris Removal 25%of covered loss , Employee Tools(applies only to those premises provided Coverage B'-Business Personal Property) Per Occurrence . $500 • . Equipment Breakdown Included • Fire Department Service Charge . $5,000 Fire.Extinguisher Systems Recharge Expense . $5,000 Policy number:'97-CR-8526-0 Page 2 of 5 Prepared:January20,2022 ©Copyright, State•Farm Mutual Automobile Insurance Company, 2008 • CMP-4000 . u c°0 StateFarm Coverage 4 �, G ; 9 Limit of Insurance _.. Forgery or Alteration : •$.10,000• Garagekeepers Insurance-Direct Coverage $25,000 Glass Expenses Included S 0 Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on•a 10% - cv o replacement cost basis) . _�:F_ • ,„ „ ✓ Money Orders and Counterfeit Money $1,000 Money and Securities On Premises • $10,000 "' ' ' ! '' Off Premises $5,000 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 - - - . -$20,000 Preservation of Property 30 days - Property of Others(applies only to those.premises provided Coverage B-Business Personal $100,000. • - 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. Coverage Limitof Insurance ' Employee Dishonesty - • - $10,000 ' Loss of Income and Extra Expense 5 ' 12 Months Actual Loss Sustained Policy number:97-CR-B526-0 Page 3 of 5 Prepared:January 20,2022 ©Copyright, State Farm;Mutual Automobile Insurance Company, 2008 CMP-4000 008365 . ' StateFarnr SECTION II-LOCATION SCHEDULE - ' Location Location of described premises number - 001 2001 NE Foothill Blvd Ste E4 ' Grants Pass OR 975264240 • - SECTION II DEDUCTIBLES • Property Damage: $250 - Other deductibles may apply-refer to policy, , SECTION II-LIABILITY - CoverageLimit of Insurance Coverage L-Business Liability Per Occurrence , $2,000,000 Coverage M-Medical.Expenses $5,000 Any One Person - Damage to Premises Rented to You•. , ._ 300,000 Garage Liability Included in Coverage L Operation of Customers'Auto.on Particular PremisesIncluded Aggregate Limits - . Limit of Insurance General Aggregate $4,000,000 • Products/Completed Operations Aggregate $4,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provideduring 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(Oregon) - . CMP-4412 . Operation of.Customers'.Auto on Particular Premises CMP-4527 Marijuana Exclusion 1 . *. CMP-4543 Additional Insured-Designated Person or Organization. - . CMP-4561.1 Policy Endorsement CMP-4683.1 ' Additional Insured-Owners,Less.4es-.or Contractors(Blanket)' - - - -- TM - , CMP-4705.2 Loss of Income and Extra Expense CMP-4706 Back-up of Sewer or Drain CMP-4709 Money and Securities ' ' ' • ' CMP-4710 Employee.Dishonesty, • ' CMP-4742,1 - Garage Liability •- CMP-4744 Garagekeeper's Insurance-Direct Coverage . CMP-4827.1 Employee Tool Coverage - FD-6007 Inland Marine Attaching Declaratiohs ' . - , . , * FE-1313 Form 438BFU NS-Lenders Loss Payable Endorsement - - FE-3650 Actual Cash Value.Endorsement FE-6999.3 Policyholder Disclosure Notice of terrorism Insurance Coverage ' *New Form Attached Policy number;97-CR-B526-0 - -- ' Page 4 of 5 Prepared;January20,2022 ©Copyright, State Farm MutuallAutomobile Insurance Company, 2006 ' CMP-4000 e StateFarms SCHEDULE OF ADDITIONAL INTEREST(S) t',• Interest type: Designated Person or Organization Endorsement number: CMP-4543 • Loan number: N/A • City of Ashland the City of Ashland,Oregon, its officers,agents,.and employees 20EMain St Ashland OR 97520-1814 (0 0 FULL NAMED INSURED Named Insured: JEREMY MANEKER DBA WRAP IT UP GRAPHICS,CITY OF ASHLAND 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, • President Secretary • • • • • • Policy number:97-CR-B526-0 Page 5 of 5 Prepared:January 20,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008, CMP-4000 • 008366 State Farm InsuranceLi PO Box 2915 Bloomington, IL 61702-2915 090 StateFarm' • State Farm Fire and Casualty Company CITY OF ASHLAND THE CITY OF AS A stock company with home offices in Bloomington, Illinois 20 E MAIN ST ASHLAND OR 97520-1814 S 0 Inland Marine Attach.ing ;Deciarations Policy number: 97-CR-B526-0 Effective date: January 18, 2022 Policy period: 12 months Expiration date: September 9, 2022 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 automaticallysubject 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. Annual policy premium: Included The above premium amount is included in the Policy Premium shown on the Declarations. FULL NAMED INSURED Named Insured: JEREMY MANEKER DBA WRAP IT UP GRAPHICS, CITY OF ASHLAND Your policy consists of these Declaration's, 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. FORMS,OPTIONS AND ENDORSEMENTS FE-6867 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 MARINE SCHEDULE PAGE • Endorsement Coverage Limit of insurance Deductible amount Annual premium number FE-8743.1 Inland Marine Computer Property Form $26,259 $500 $8 Loss of Income and Extra Expense $25,000 Included • • Other limits and exclusions may apply-refer to your policy. • Policy number:97-CR-8526-0 Page 1 of 1 Prepared:January 20,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CIM Att Dec 3P OR.1 FD-6007 1009481 2002 153089 202 03.06.2021 008367 CMP-4543 • Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. y ' 4 ADDITIONAL INSURED —DESIGNATED PERSON OR ORGANIZATION • • This endorsement modifies insurance provided under the following; g BUSINESSOWNERS COVERAGE FORM • SCHEDULE Policy Number: 97-CR-B526-0 Named Insured: JEREMY MANEKER DBA WRAP IT UP GRAPHICS, CITY OF ASHLAND 479 MARION LN GRANTS PASS OR 97527-5570 Name And Address Of Additional Insured Person Or Organization: City of Ashland the City of Ashland, Oregon, its officers, agents, and employees 20 E Main St • Ashland OR 97520-1814 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 for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Premises And Ongoing Operations - Your acts or omissions or the acts or omissions of those acting on your behalf: (1) In connection with your premises; or (2) In the performance of your ongoing operations; or • b. Products-Completed Operations • "Your work" performed for that additional,insured and included,in the "products-completed operations hazard". 2. 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.. 3. 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.provided by you. All other policy provisions apply. CMP-4543 154861 04-17-2018 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2018 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 008368 '