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HomeMy WebLinkAboutInsurance Certificate: Wild Rivers Surveying LLC State Farm at CityLine PO Box 853925 ; Richardson, TX'75085-3925 , 090 5085 3925a0 (►tateFarnia AT2 000623 1200 01 State.Farm Fire and Casualty Company THE CITY OF ASHLAND A stock company with home offices;ih,Bloomington;Illinois 20 E MAIN ST ' ASHLAND OR 97520-1814 , t . g • - i 111111"111111'111111111111111111111111111""1111111'1"11'1'11r 0o . -Renewal' Declarations' Policy number 97-CN-X256-3 Effective date, January 24, 2022 Policy period: 12 months 'Expiration date: January 24, 2023 ' • The policy period begins and ends at 12:01 am standard time at the premises location. - BUSINESSOWNERS POLICY : Automatic renewal -If the State Farm!..policy,periodtis,shown,-as\l2-months;;#his'policy,will be renewed•automatically.subjeet to,the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the 7-- - Mortgagee/Liienholder�written-noticeJirrcompliance=withthe-policy=provisions-or-as-required,by law: r- ----- — NAMED INSURED ' . . _. , • . ' , ,,. WILD RIVERS SURVEYING,.LLC , ENTITY ._ _ Limited Liability. Company' IMPORTANT MESSAGE(S) • . . ' Notice :Information concerning changes inyour policy language is included. Please call your agent if you have anyquestions„ POLICY ... ,. - - , , This is not a bill.If an amounte,is duthen a separate statement will be sent prior to the due date. The premium(s)shown below is the12-'months ' premium(s)for the characteristics of the'policy.as described in this Declarations. - . . , Total Premium: $406.00 ' - ' - . Discounts applied: • Business Experience Rating Renewal Discount - Years in Business -- -- .. Business in Residence Premises - . Policy Number:97-CN-X256-3 Page 1 of 5 Prepared:November 16,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2006 ' CMP Dec 3P OR.1 1009482 2005 153090 205 06-21.2021 CMP-4000 ' 002553 • c_)96 StateFarm® SECTION I 7 PROPERTY SCHEDULE • - Location Location of described premises Limit of Insurance* Limit of Insurance* Seasonal increase-c• number " Coverage A Coverage B-Business Business Personal Property Building Personal Property 001 3339 GREEN ACRES DR, No Coverage $28,600 , 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—INFLATION COVERAGE INDEX(ES) Cov A-Inflation Coverage Index: N/A Coy B-Consumer.Price Index: 274.3 SECTION I--DEDUCTIBLES • BASIC DEDUCTIBLE . $500 • SPECIAL DEDUCTIBLES: • t. •,• • Employee Dishonesty: $250 Equipment Breakdown: $500 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 shown below apply separately to each described preinisesePowri ih'theele unless indicated by'See schedule". If a coverage,dbes not have a correspondinglimit hon belbw, but has"Included'' fidiCated, refer to that policy provision for an explanation ofthat coVerage:. Coverage Limit of Insurance. • Accounts Receivable On Premises $10,000 Off Premises $5,000 .5 Arson Reward $5,000 — Collapse Included Damage to Non owned Buildings from tbeft,Burglary or Robbery ' CoVerage‘6 Limit . • • Debris Removal • 25%of covered loss • s Equipment Breakdown ' Included Fire Department Service Charge • $2,500 Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration $10,000 Glass Expenses Included , Policy Number:97-CN-X256-3Page 2 of 5 Prepared:November 16,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 • • oo StateFar� me Coverage, '' Limit of Insurance '1-'' '~,,: •, • ir.: Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on.a 10% replacement cost basis)• ,- - ... - - - Money Orders and Counterfeit Money . . - • - $t000 - - Money and Securities - - - . . • o 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=.BusinessPersonal Property) . $2,500 . . Personal Property Off Premises $15,000 . • _ „ . _, .• ;•iy';, • 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 • t 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 ;,,,, .'I ri'.t. 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 Employee Dishonesty . $5,000 - ' • I Loss of Income and Extra Expense 12 Months Actual Loss Sustained SECTION II-LOCATION SCHEDULE 0 Location Location of described premises • number • 001 3339 GREEN ACRES DR CENTRAL POINT OR 97502-1413 • Policy Number:97-CN-X256-3 • Page 3 of 5 Prepared:November 16,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 0 , . CMP-4000 002554 • : : StafeFarn® SECTION II-LIABILITY , , Coverage ,. • .. :. .Limit of Insurance { Coverage L-Business Liability Per.Occurrence $2,000;000 . . - . _ . , 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 , - . . , • ,., . ,•$5,000;000, , • . General Aggregate:. $5,000,000 , , . 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 policyconsists of these.Declarations,the BUSINESSOWNERS COVERAGE FORM shown below,and any other forms andendorsements 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-4527 Marijuana Exclusion. * CMP-4543 ' Additional Insured-Designated Person,or Organization .. , . 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 . CMP-4710 Employee Dishonesty - . • - 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-6999.3 Policyholder Disclosure Notice of Terrorism Insurance Coverage '. . ' •• *New Form Attached ( SCHEDULE OF ADDITIONAL INTEREST(S) , Interest type: Owners,Lessees,.or Contractors(Schedul . . . Endorsement number: CMP-4684.1 Loan number: N/A , The City of Ashland - .- .-. - 20 E Main St Ashland OR 97520-1814 - - . . -,« Policy Number:97-CN-X256-3 S Page 4 of 5 . Prepared:November 16,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 , & StateFarrno 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 o Bloomington, Illinois. /41444&44--Q1-----4k4,-0 President Secretary 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. 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 16,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 002555 . State i-arm at L Ityune • PO Box 853925 Richardson, TX 75085-3925 0°0 C fate arm State Farm Fire and Casualty Company THE CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 17,kr. 20'E MAIN ST s.-ex ASHLAND OR 97520-1814 O C O o Inland Marine Attaching Declarations Policy number: 97-CN-X256-3 Effective date: January 24, 2022 Policy period: 12 months Expiration date: January24, 2023 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 theissuance of this policy. FORMS,OPTIONS AND ENDORSEMENTS 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 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-CN-X256-3 Page 1 of 1 Prepared:November 16,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR.1 1009481 2002 153089 202 03-06-2021 FD-6007 002556 • • CMP-4684.1 • ' Page 1 of 1 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • :.!°ADDITIONAL INSURED—OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: o BUSINESSOWNERS COVERAGE FORM o SCHEDULE Policy Number: 97-CN-X256-3 Named Insured: WILD RIVERS SURVEYING, LLC . 20EMain St • Ashland OR 97520-1814 Name And Address Of Additional Insured Person Or Organization: • The City of Ashland 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: a. Ongoing Operations • • With respect to liability for "bodily injury", "property damage", or 'personal and advertising injury" caused by your ongoing operations for that additional insured and only to the extent_that such "bodily injury", "property damage" or "personal and advertising injury" is caused by your negligence or the negligence of those performing operations on your behalf; or b. Products-Completed Operations.. To the extent that the liability for "bodily injury" or"property damage" is caused by "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 coverageprovided by you. All other policy provisions apply. • CMP-4684.1 155042 03-20-2019 • ' ©, Copyright, State Farm Mutual Automobile Insurance Company, 2018 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. • • • • • • 002557 •