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HomeMy WebLinkAboutInsurance Certificate: Straw ,Donald E DBA Fashion FL PO Box 2915 O StateFarm° Bloomington, iL 61702-2915 AT1 000192 1200 01 . State Farm.Fir,e,and Casualty Company CITY OF ASHLAND 'A stock company with horne'offices`ii Bloomington, Illinois 90 N MOUNTAIN AVE el-''': ASHLAND OR 97520-2014 , . - a rlliiiI'IIIIIIIIIIII'IIIiiIiuIl'IIIIliiiiiiiI'IIIIIIII'IIIIIIIriI- - . . . -.. _ . Amended . Declara'tions . ; • . i , . . . . . Policy number:97-CP-D437-8 . Effective date:January 20, 2022, - , • • Policy period: 12 months Expiration date:February 18,2022 The policy period begins and ends at 12:01 am standard time at the premises location. HOME PRODUCT SALES POLICY ..,, •• 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. - ' . -, - -=- 7-2-7" NAMED STRAW, DONALD E DBA FASHION FL , „ . ENTITY ' ' , . Sole Proprietorship-Individual • REASONS FOR DECLARATIONS ' ' •' Your policy is amended effective January 20,2022 due to some,recent policy changes you requested. Enclosed is'a cop_y'of your new endorsements, if any. • ' ' 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: $1.00 ' . - . - . . . Discounts applied: . - , Business Experience Rating Renewal Discount .. . . Protective Devices Years in Business - • Policy number:97-CP-D437-8Page 1 of,6 Prepared:January 26,2022 ©Copyright,State Farm Mutual,Automobile,Insurance Company, 2008 CMP Dec 3P OR.1 CMP-4000 1009482 2005 153090 205 08.21-2021 000748 • 0 o StateFarmo SECTION I-PROPERTY SCHEDULE—BLANKET Limit of Insurance* .• ' Coverage A-Buildings: $961,200 . . . Coverage B-Business Personal Property: $432,800 Location Location of described premises Seasonal Increase- number Business Personal Property • 001 427 N RIVERSIDE AV 25% MEDFORD OR 97501-4602 003 516 S FIRST 25% • MEDFORD'OR 97501-3616 *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: 190.2 , . • Coy B-Consumer Price Index: 260.4 , ' SECTION I—DEDUCTIBLES ' ' • • - ' ' - ' •• ' BASIC DEDUCTIBLE $1;000 . SPECIAL DEDUCTIBLES: ;`,„^-; `' "e ' ` ' „ '• Employee Dishonesty:, $250 ., . • Equipment Breakdown: $1,000 . 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 premises showifin 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 i..', - ,•. ..,.; ,. Accounts Receivable . , See Schedule . Arson Reward $5,000 . ' , • • Back-up of Sewer or Drain See Schedule •' .',I:-.: :—..I • - `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 Policy number:97-CP-D437-8 . Page 2 of 6 Prepared:January 26,2022 ©Copyright, State Farm Mutual Automobile Insurance Company;;2008. . CMP-4000 . 0o StateFarm® • Coverage - Limit of Insurance , • Nyi Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a 10% - • ' replacement cost basis) Money Orders and Counterfeit Money $1,000 , § Money and Securities .• See Schedule Ncs, 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 - - • See Schedule• - - - • Personal Effects(applies only to those premises provided Coverage•B-Business Personal Property)- $2,500 Personal Property Off Premises - - $25,000' - - - - • 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 See Schedule , - . Property) • Signs See Schedule - Valuable Papers and Records • - . - See Schedule • Water Damage, Other Liquids,-Powder or Molten Material Damage .. - • Included -- SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-SCHEDULE -i-: ' . • :-:1 • The coverages and corresponding,limits shown below apply only o the ,described premises as shown. Location Coverage Limit of Insurance . number 001 Accopnts Receivable On Premises Limit- - $10,000 • • - - Off Premises Limit - $5,000 :.. • - Back-up of Sewer or Drain $15,000 Money and Securities . - - On Premises Limit $10,000 Off Premises Limit • - $5,000 ' • Outdoor Property - . $5,000 , . Property of Others(applies only to those premises provided Coverage $2,500 B-Business Personal Property) .. .- Signs . . $5,000 - • Policy number:97-CP-D437-8 Page 3 of 6; Prepared:January 26,2022 ©,Copyright, State Farm Mutual Automobile Insurance Company, 2008 • CMP-4000 ' 000749 • 00 StateFarms Location Coverage - -• • ' • Limit of Insurance • number-. - . - - .- .. -. , . Valuable Papers and Records • On Premises Limit $10,000 • Off Premises Limit • $5,000 .. 003 Accounts Receivable ' On Premises Limit $10,000 • Off Premises Limit - - - - $5,000 Back-up of Sewer or Drain -- $15,000 - - - - • • - Money and Securities . . • - • On Premises Limit $10,000 Off Premises Limit • - $5,000' • Outdoor Property -• - $5,000 Property of Others(applies only to those premises provided Coverage- $2,500 B-Business Personal Property) - . • Signs • - - $5,000• Valuable Papers and Records . • • - - . . • On Premises Limit • • $10,000 • - •- - .. Off Premises Limit - - • -• - - • - •$5,000•• • is , i ,','-''!' ':I•l. ..+ ;ti7 ;t., 1, •,. -. '!. ,..,,, . ..' 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 Coverage •_ -. - -Limit of Insurance Dependent Property Loss of Income $5;000 - Employee Dishonesty $10,000 - Loss of Income and Extra Expense 12 Months Actual Loss Sustained • Utility Interruption-Loss of Income. • • , • $10,000 • • SECTION II-LOCATION SCHEDULE - - - Location - Location of described premises number 001 427 N RIVERSIDE AV MEDFORD OR 97501-4602 - •- - • • '' 003 516 S FIRST MEDFORD OR 97501-3616 , - • ' Policy number:97-CP-D437-13 •Page 4 of 6 Prepared:January 26,2022 ©Copyright, state Farm Mutual Automobile'Insurance Company, 2008 • CMP-4000 ' o StateFarm® SECTION II-DEDUCTIBLES , = . Property Damage: - $250 • •=fv. Other deductibles may apply-refer to policy. . SECTION II-LIABILITY , § Coverage Limit of Insurance . o Coverage L-Business Liability Per Occurrence $1,000,000 Coverage M-Medical Expenses $10,000 Any One Person , Damage to Premises Rented to You $300,000 . Hired Auto Liability Included in Coverage L - - . • Aggregate Limits ,. .Limit of Insurance . . General Aggregate $2,000,000 Products/Completed Operations Aggregate $2,000,000 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 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-4527 Marijuana Exclusion . CMP-4561.1 Policy Endorsement • CMP-4610.1 General Aggregate Limits of Insurance(Per Project) CMP-4683.1 Additional Insured-Owners,Lessees or Contractors(Blanket) CMP-4684.1 Additional Insured-Owners,Lessees or Contractors(Scheduled) CMP-4703.1 Utility Interruption-Loss of Income CMP-4704.1 Dependent Property-Loss of Income 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-4746.1 Hired Auto Liability CMP-4787 Waiver of Transfer of Rights of Recovery Against Others To Us • CMP-4839 Loss Payable FD-6007 Inland Marine Attaching Declarations FE-3650 Actual Cash Value Endorsement FE-6999.3 .Policyholder Disclosure Notice of Terrorism Insurance Coverage ' SCHEDULE OF ADDITIONAL INTEREST(S) • Interest type: Owners,Lessees,or Contractors(Schedul Endorsement number CMP-4684.1' Loan number: NIA CITY OF ASHLAND 90 N Mountain Ave ' Ashland OR 97520-2014 FULL NAMED INSURED Policy number:97-CP-D437-B Page 5 of 6 Prepared:January 26,2022 ©Copyright, State Farm Mutual Automobile Insurance Company,.2008 •. CMP-4000 0 000750 ' • o&StateFarm® Named Insured: STRAW,DONALD E DBA FASHION FLOORS ' 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 Incorpo'ration, 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 • • • • • J Policy number:97-CP-D437-8 Page 6 of 6 Prepared:January 26,2022 .©Copyright, State Farm Mutual Automobile Insurance Company, 2008, CMP-4000 PO Box 2915 ,/ ,/,B y�. Bloomington, IL 6i702:-.2915 090 StateFaI/.m State Farm Fire and Casualty Company y CITY OF'ASHLAND ' '" • A stock company with home offices'in Bloomington, Illinois 90 N MOUNTAIN AVE - 5--.1. ASHLAND OR 97520-2014 • . .. S - , • 0 • • Inland, Marine Attaching Declarations , • •• Policy number: 97-CP-D437-8 Effectjye date: January 20, 2022 Policy period: 12 months Expiration date: February 18,2022 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 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 bylaw. Annual policy premium: $374.00 The above premium amount is included In the Policy Premium shown on the Declarations. FULL NAMED.INSURED Named Insured: STRAW, DONALD E DBA FASHION FLOORS 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. FORMS,OPTIONS AND ENDORSEMENTS , FE-6867 Amendment of Inland Marine Conditions • FE-8739 • Inland Marine Conditions ' FE-8743.1 Inland Marine Computer Property Form FE-8754 Inland Marine Dealers•Service 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 FE-8754 Inland Marine Dealers-Service Form $500 $374 Policy number:97-CP-D437-8 Page 1 of 2 Prepared:January 26,2022 O Copyright, State Farm.Mutual Automobile Insurance company, 2008 - , CIM Att Dec 3P OR.1 FD-6007. .1009481 2002 153089 202 03.05-2021. 000751 0°6 State Farme • Endorsement Coverage . Limit of insurance Deductible amount s. Annual.premium number Description of Property:FLOOR COVERINGS&TOOLS 1.Insureds property on customers premises limit $10,000 2.Customers property in insureds custody limit $10,000 3.Property in transit limit $5,000 4.Tools,Servicing Equipment,Spare Parts limit $2,000 Other limits and exclusions may apply-refer to your policy. • • • " r • • • Policy number:97-CP-D437-8 Page 2 of 2 Prepared:January 26,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 200S• FO-6007