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HomeMy WebLinkAboutInsurance Certificate: Rogue Boiler Works LLC 3wrerarm S I H I C rHFSM nut AMU L MSUAL I I UUWIPAiv Y U 0 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,ILLINOIS RENEWAL DECLARATIONS 0'0® P9 Box.BBox 853925 Richardson, TX 75085 3925 5 _ ..Policy Number 97-CM-N878-7 4 " 'Replaces Number '97;CM�L796-1` '' Addl Insured-Section II Only Policy Period Effective Date Expiration Date AT1 M-15-2275-FAE6 F E 1 Year JAN 2 2022 JAN 2 2023 001075 3125 The poli y period beggins and ends at1Z:01 am standard T IT ASHLAND OREGON time atthepremises location. TS OFFICERS, NTS AND R 90 N MOUNTAIN AVE Named Insured l'W,4 ASHLAND OR 97520-2014. ROGUE BOILER WORKS LLC Yi 8 IIIIIIIlnlll111111iIIlll1ll1l1l111"1Illillll'iIIIIIIIIIIIIIIIII 0 q o . Artisan And Service Contractor Policy • _; Automatic Renewal-lithe policy period is shown as 12 months,this policywill 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/Lienholder`written notice in compliance with the policy provisions or as required by law., Entity: Limited Liability Company _ , NOTICE: ;Information concerning changes in your policy language is included. Please call your agent if you have any questions. • _ :. • Total Estimated ' Premium $ 2,670.00 Audit Period: Annual Discounts Applied: Renewal Year Years in Business Claim Record iI Prepared . NOV 04 2021 ©Copyright,State Farm Mutual Automobile,Insurance Company,20D8 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 006709 294 Al Coritinued'on Reverse,Side of Page Page ' 1 of 6 ni RENEWAL DECLARATIONS(CONTINUED) Artisan And Service Contractor P.olicy'for THE CITY OF ASHLAND,OREGON Policy Number : 97-CM-N878-7 • 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 Personal. Personal ;' , • , Property Property - 001 2105 COREY RD No Coverage ` $ ' 79,000. '25%o• CENTRAL POINT OR 97502-9405 . • *As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the'limit due to lhflation Coverage. SECTION.I INFLATION COVERAGE INDEX(ES) 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 04 2021 a Copyright,State Farm Mutual Automobile Insurance Company,2003 CMP-4000 OR Includes copyrighted material of Insurance Services''Office;.Inc„with its permission. • •006709 Continued,on Next Page Page 2 of 6 Jrarerarm LJ O 00® RENEWAL DECLARATIONS(CONTINUED) Artisan And Service Contractor Policy'for THE CITYOF ASHLAND,'OREGON r. - ; - Policy Number 97-CM-N878=7 �•. , • SECTION I - EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE- EACH DESCRIBED PREMISES: o , 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, please,refer,to that policy provision for,an explanation,ofthat.coverage. LIMIT OF COVERAGE 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 :.,R 25%0;of-covered•lo'ss, Equipment Breakdown • Included Fire Department Service Charge $2,500 Fire Extinguisher Systems Recharge Expense $5,000 • • Forgery Or Alteration : . - - . - .-- • - - - - - • • - x $10,000 Glass Expenses Included Increased Cost Of.Construction And Demolition Costs (applies only when buildings are 10% 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 042021 Copyright,State Farm Mutual Automobile Insurance Company,2008 — CMP-4000 OR Includ4 copyrighted materiel'of Insurance Services Office,fñc.,wih its permission. S` 006710 294 Continued'on'Reverse Side of Page Page ' 3 Of 6 nl , RENEWAL 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 UP And Removal oP ' $10,000 Preservation'Of Property 30 Days Property'Of Others•(applies only'to those`premises provided Coverage B= Business ' - $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 Included SECTION II- DEDUCTIBLES Business Liability-'Property Damage $500 Other deductibles may apply- refer to policy. SECTION II-LIABILITY • LIMIT OF COVERAGE INSURANCE Coverage L- Business Liability' $2,000,000 Coverage M - Medical Expenses (Any One;Person) $10,000 Damage.To Premises Rented To You $100,000 LIMIT OF AGGREGATE LIMITS INSURANCE •• • . .'s Products/Completed Operations Aggregate $4,000,000 Prepared NOV 04 2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes'copyrighted material of Insurance Services Office,Inc with its permission. 006710 Continued on.Next Page Page 4 of 6 Jrarerarm _ L I o -.. oo® . RENEWAL DECLARATIONS(CONTINUED) Artisan And Service Contractor Policy for THE CITY OF ASHLAND,OREGON. - ..-: • • - , " ' Policy Number 97-CM-N878-7 ' , General Aggregate $4,000,000 ti 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. 0 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. • . .. • . . . V - • FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form FE-6999.3 *Terrorism Insurance Coy Notice • • CMP-4600 Artisan and Service Contractor _ 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-4684.1 Addl Insd Owners Lessee Sched CMP-4787 Waiver of Trans Rgt of Recov . . • ' . • '- • CMP-4527 .. ' ..,'-Excl Ctrl Substances V CMP-4875 Loss Payable • ' . ' . , . - V FD-6007 ' Inland Marine Attach Dec ... ' ' - ' ' 1? ` ' ' * New Forrri:Attached' - r•. • • Prepared NOV 04 2021 ©Copyright,'State Farm Mutual Automobile Insurance Company,2008 > CMP-4000 OR Includes copyrighted'iraterial of'Insurence Services Office ,Inc.,with its permission. ' 006711 294 Continued on Reverse Side of Page Page 5 of -6 RENEWAL.DECLARATIONS(CONTINUED) Artisan And Service Contractor Policy,for.THE'.CITY OF ASHLAND,OREGON . Policy Number 97-CM-N878-7 • ° 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 hascaused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President • • • NOTICE TO POLICYHOLDER: Fora comprehensive description of coverages 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 amendeddeclarations oras an endorsement•to your policy. Billing for any additional premium for suchchanges will be mailed ata 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. • • • Prepared - NOV 04 2021 ©Copyright,State Farm Mutual Automobile,Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc'.,with its permission. • , 006711:_294 • Page 6 of. 6 N . maretarm STATE FARM FIRE AND CASUALTY COMPANY LJ 00 A STOCK COMPANY WITH HOME OFF,ICES.INBLOOMINGTON,ILLINOIS INLAND MARINE ATTACHING DECLARATIONS ® PoBxd853TX55750853925 Policy Number 97-CM-N878-7 Replaces Number 97-CM-L796-1 Named Insured Policy Period Effective Date 'Expiration Date • M-15-2275-FAE6F E . 1 Year. JAN 22022, , JAN 2 2023 The.poli y period begins and ends at12:01 am standard rA = , . . , ROGUE BOILER WORKS LLC . time Attie premises Tocation. G p O ATTACHING INLAND MARINE - . ' ' 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 thispolicy is terminated,we will give you and the Mortgagee/Lienholder written notice in compliance with thepolicyprovisions or as required by law. . Annual Policy Premium . $ 100.00 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 aswell 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 1.. Prepared NOV 04 2021Co Copyright,State t Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc„with its permission. . 006712 can.cnc..a fC_a1_'In11 l,1Vlaaa ` ATTACHING INLAND MARINE SCHEDULE PAGE • 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 Equipment Form $ 20 ,000 $ 500 $ 100 . 0( FE-8756.1 Installation Endorsement $ 5,000 $ - 500 Included Property in Transit $ 5,000 • Number of Job-Sites: 1.. • • • • • • • • • • • • . r "i ;•,. -. r+ .ter ,. OTHER LIMITS AND EXCLUSIONS MAY APPLY-REFER TO YOUR POLICY Prepared NOV 04 2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008• FD-6007 "Includes copyrighted material of Insurance Services' Office,Inc.,with its permission. 006712 536.666 8.2 65-31-2611 101132331