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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald (11) State Farm at CityLine U PO Box 853925 ' Richardson, TX•75085-3925 4'O StateFarn'r All 000299 1200 01 . , State Farm Fire and Casualty.Company CITY OF ASHLAND A stock company with homeoffiaes in Bloomington, Illinois i' 90 N MOUNTAIN AVE - , . : ...'31.7:;', ASHLAND OR 9.7520-2014 , S 1-$ IIhhII111111111111llhIll'lih1IIhI11rl1Ill'III"iiIIII""iiuHI . __ _ • Amended Declarations ' . r, . . . , . , ;.:.„:„...:,-,-,„ , ,„, „..„:„., : ,,t .r)-.. '1'; .'., "!'', -"-,-', Policy number:97-CP-D437-8 Effective date:February 18,2022 n" Policy period: 12 months Expiration date:February 18, 2023 . , ' 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 Suc•ceeding policy period. If this policy is terminated, we will give-you.and the;',' . .-Mortgagee/Lienh'olderwritten notice in cornplience'with the policy proVisions or as required bylaw, , NAMED INSURED • m STRAW, DONALD E DBA FASHION FL , , .. . . , . ENTITY ..• . , ' .. Sole Proprietorship-Individual REASONS FOR DECLARATIONS ' ' • ' Your policy is amended effective February 18, 2022 due to some recent policy'changes you requested; Enclosed is''a copy,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 prier 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: $16.00 Discounts applied: , , Business Experience Rating .- Renewal Discount - - -- Protective Devices Years in Business " Policy number:97-CP-D437-8 Page 1 of 6 Prepared:December 15,2021 ©Copyright, State Farm;Mutual Automobile Insurance Company, 20D8. ••• CMP Dec 3P Oki CMP-4000 1009462 2005 153090 205 08-21-2021 001141 . 090 State F- SECTION I=PROPERTY SCHEDULE.:.-BLANKET . Limit of Insurance" 5' Coverage.A-Buildings: $1,029,500 • . Coverage B-Business Personal Property: $456;000 • 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: 203.7 - . Coy B-Consumer Price Index: 274.3. . SECTION I-DEDUCTIBLES BASIC DEDUCTIBLE $1,000 ' SPECIAL DEDUCTIBLES: -' ° '"`' ' Employee Dishonesty: , 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 shown in 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 , f „ ..r.. , Accounts Receivable 1 - , 0 - , ,See Schedule - Arson Reward $5,000 Back-up of Sewer or Drain - See Schedule c,' ,: :-1%:: 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-B Page 2 of 6 Prepared:December 15,2021 ©Copyright, State Farm Mutual Automobile'Insurance Company, 2008 • • . CMP-4000 . u CLQ State a A a • Coverage Limit of Insurance pit . 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 - S Money and Securities See Schedule N . 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 The coverages and corresponding limits shown below apply only to the described premises as shown, Location Coverage Limit of Insurance , number 001. Accounts_Receivable .. - _. .. _. . . . .. _ . _.. . ..- _ .,. v On Premises Limit . -. . • .. • _.$10,000 . Off Premises Limit _ ., ..$5,000. ... , Back-up of Sewer or Drain .- $15,000 - ' - - Money and Securities" - . . '. ._ . -, . .__ . . On Premises Limit p'-'- F $10,000 Off Premises Limit ' $5,000 ' ' -1' ' 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:December 15,2021 ©Copyright, State Farm Mutual,Automobile,Insurance Company, 2008, , CMP-4000 001142 . -' 090 StateFarme LocationCoverage 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 onlyto thosepremises.provided Coverage $2,500 - B-Business Personal Property) • ;",,J.' , .. 'Signs $5,000.. ,; .. , • • Valuable Papers and Records • On Premises Limit •• •- - . $10,000 • Off Premises Limit $5 ,000 - .. ,!.I 1. .... .,pA ,? .' l•,. s -,,,.:r , - SECTION I—EXTENSIONS OF COVERAGE-LIMITOF 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 .. . .. •.b. ' ._Limit of Insurance — Dependent DependentProperty-Loss of Income - .. $5;000, ' Employee Dishonesty - . ' $10,000 Loss of Income and Extra Expense • i • .. . .. 12 Months Actual Loss Sustained Utility Interruption'-Loss of Income . • . •. • $10,000 - SECTION II-LOCATION.SCHEDULE • • ' Location ' Location of described premises number ' . 0 . 001 427 N RIVERSIDE AV MEDFORD OR 975014602 003 516SFIRST , • MEDFORD OR 97501-3616 ' " Policy number:97-CP-D437-8 ' • ' ' Page'4 of 6 Prepared:December 15,2021 ©Copyright, State Farm'Mutual Automobile Insurance'Company; 2008 . CMP-4000 : . ' . , , • u -k. 5,,°./.State/ a m® SECTION II-DEDUCTIBLES Property Damage: $250 Other deductibles may apply-refer to policy. • SECTION II-LIABILITY Coverage Limit of Insurance • 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 Coyerage 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 *New Form Attached . . . • • • 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 Policy number:97-CP-D437-8 • Page.5 of 6 Prepared:December 15,2021 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008„ CMP-4000 • 001143 . 00StateFarnr FULL NAMED INSURED • Named Insured: STRAW,DONALD E DBA FASHION FLOORS This policy is issued by the State Farm Fire and Casualty Company. F, 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. )11 President Secretary • • f. , Policy number:97-CP-D437-8 Page 6 of 6 Prepared:December 15,2021 ©Copyright, State farm`Mutual AutomobileInsurance'Company,'2008 CMP-4000 state rarm at t,.ltyune • • L PO Box 853925 • Richardson, TX, 75085-3925 090 St'ateF'arme State Farm Fire and Casualty Company _•• , CITY OF.ASHLAND ' ' ' A stock company with home ofiioes in Bloomington,;Illinois . 90 N MOUNTAIN AVE .. -. .. _ __ _ ., ASHLAND OR 97520-2014 . �f . _ . Inland Marine AttachingDeclaratiohs • •. . ,. . . . . Policy number: 97-CP-D437-8 Effective date: February 18, 2022 Policy period: 12 monthsExpiration date: February 18,2023 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: $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:December 15,2021 ©Copyright;,State Farm Mutual Automobile Insurance Company,;2008 1; CIM Att Dec 3P OR.1 • FD-6007 1009481 2002 153089 20203.06.2021 , 001144 • oQ State Farm® 'Endorsement , Coverage Limit of insurance Deductible amount 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: • • • •,.. Policy number:97-CP-D437-8 Page 2 of 2 Prepared:December 15,2021 ©Copyright;'State Farm Mutual Automobile Insurance Company, 2008 • FD-6007 ,