Loading...
HomeMy WebLinkAboutInsurance Certificate: Straw, Donald E DBA Fashion FL (2) State Farm at CityLine PO Box 853925 Richardson,•TX75085-3925 C Q S#aeFarn' AT2 001054 1200 01 State Farm Fire and Casualty Company • CITY OF ASHLAND A stock company with hotneoffices in Bloomingtoh,f-Illinois. tf 4.' 90 N MOUNTAIN AVE =.1"} ASHLAND OR 97520-2014 • II1IIII �IIIIIIIllli II�IIII IIIlllhili lII I II °A ,-o Renewal Declarations, -, 3 :.; ` • , rs ,, ' ' , . , + ' f, ;1 , F • Policy number 67t1371)437-8.` ; ` Effectivedate-:Fe6ruary 18, 202 ' , - , • 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.succeeding;policy period If this policy is terminated,;we will_give yoitand=the i ' ,- ;Mortgagee/Lienhblder written-notiee'-in compliance,-with,theTpolicy-provisions'or as require by law.• , NAMED INSURED • STRAW, DONALD E DBA FASHION FLOORS,, ';.-•-. ... - 1'', • . . :. ..' . t....,; -. ; 0.:',",;:t.- ' ,, ...-... . ENTITY Sole Proprietorship-Individual IMPORTANT MESSAGE(S► Notice= Information-concerning chlanges inyour policy language,is included Please call your agent if you have,any questions . ,.j f 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 preinium(s)-shown below is the"12 Months ;': premium(s)for the characteristics of the policy;as described in this,Declarations. . Total Premium: $5,358.00 ' . Discounts applied: , - .: Business.Experience Rating . . . •. . •:Renewal Discount • ' -. Protective Devices. Years in Business. , � r a , l Policy Number:97-CP-D437-8 • Page 1 of 6 ;` Prepared:December 11,2021 ©Copyright,State Farm Mutual Automobile•Insurance Company,2008 CMPDec CMP-4000 4000 ORA1009482.2005 153090 205 08-21.2021 004557 . _. Q d StateFarme SECTION I-PROPERTY SCHEDULE—BLANKET Limit of insurance*. 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: • , . , , . s .. Employee Dishonesty: .$250 Equipment Breakdown: $1,000' Money and Securities: $250 'Other deductibles may apply-referto 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 Accounts Receivable See Schedule ' Arson Reward $5,000 Back-up of Sewer or Drain , . . , See Schedule • 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 Page2of6 Policy Number.97-CP-D437-8 ' Prepared:December 11,2021 ©.Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 oQ State Farms Coverage Limit of Insurance - , "J~ Glass Expenses - .. . -. ... . Included 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 o Money and Securities See Schedule 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-EquipmentCoverage Included - Outdoor Property See Schedule Personal Effects(applies only to those premises provided Coverage B-Business Personal Property) $2,500 Personal PropertyOff Premises $25,000 Pollutant Clean Up and Removal $10,000 Preservation of Property 30 days ' Property of Others(applies only to those premises provided Coverage B-Business Personal Property) See Schedule ' Signs See Schedule Valuable Papers and Records - See Schedule Water Damage, Other Liquids,Powder or Molten Material DamageIncluded. SECTION I-EXTENSIONS OF COVERAGE LIMIT OF INSURANCE'=SCHEDULE The coverages and corresponding limits shown below'apply only to.the described premises as shown. Location Coverage Limit of Insurance number • 001 Accounts Receivable • - On Premises.Limit -$.10,000.. Off Premises Limit $5,000 . -• - Back-up of Sewer or Drain • ' $15,000 Money and Securities i,r,R Ii`; i •. On Premises.Limit $10,000 .. Off Premises Limit $5;000 Outdoor Property , . $5,000 ' Property of Others(applies onlylo those premises provided.Coverage B-Business $2,500 , Personal Property) Signs. $5 000 • Policy Number:97-CP-D437-8 V V Page 3 of 6 Prepared:December 11,2021 ©Copyright,State Farm Mutual Automobile.Insurance Company,2008 • CMP-4000 ' 004558 o StateFarime 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 B-Business $2,500 _ Personal Property) "Signs $5;000 LL Valuable Papers and Recortls On Premises Limit $10,000 Off Premises Limit $5,000 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 premisesshown in these Declarations. 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 NI RIVERSIDE AV _. MEDFORD OR 97501'4602 - 003 516SFIRST MEDFORD OR 97501-3616 Policy Number:97-CP-D437-8 Page 4 of 6 Prepared:December 11,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 . u • • Qa Stc� e�c7l'/I1® SECTION II-DEDUCTIBLES • �=,i,4 Property Damage: $250 • _?'P'Other deductibles may apply-refer to policy. . . SECTION II-LIABILITY . § Coverage • Limit of Insurance '1-:,, y o Coverage L-Business Liability Per Occurrence • : . r $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 Products/Completed Operations Aggregate ' , $2,000,000 • General 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 Il— 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 shownbelow 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) ' . V • CMP-4703.1 Utility Interruption-Loss of Income " 'CMP-4704:1 ' Dependent'Property:-Lass'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 Terrorismtnsurance 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 CITY OF ASHLAND • • 90 N Mountain Ave Ashland OR 97520-2014 Policy Number:97-CP-D437-8 . • • ' , . Page 5 of 6 Prepared:December 11,2021 , ©Copyright;State Farm Mutual Automobile Insurance Company,2008 . CMP-4000 • '004559 StateFarm's • FULL NAMED INSURED 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'Incorporation, as amended. ' In Witness Whereof, the StateFarm Fire and Casualty,Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. • President Secretary • - NOTICE TO POLICYHOLDER: Fora 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,aAcoverage 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 yourstructure. 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 anychanges or additions to your structure. Policy Number:97-CP-D437-8 Page 6 of 6 Prepared:December 11,2021 ©Copyright,State Farm Mutual Automobile Insurance;Company,2008 CMP-4000 state rarm at uityune PO Box 853925 Richardson, TX75085-3925 0 State L®arme • State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 90-N MOUNTAIN AVE w ASHLAND OR 97520-2014' • Inland Marine Attaching Declarations Policy number: 97=CP-D437-8 Effective date: February 18, 2022 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,, 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 Inland Marine 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 Policy Number:97-CP-D437-8 Page 1.of 2 Prepared:December 11,2021 ©Copyright,State Farm'Mutual Automobile Insurance Company,2008 ' CIM A@ Dec 3P OR.1 10094612002"153069 202 03.06-2021, FD-6007 004560 aQ StateFarrn Endorsement• Coverage " u Limit of insurance Deductible amount Annual premium number. FE-8754 Inland Marine Dealers-Service Form $500 $374• 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 I $2,000 Other limits and exclusions may apply-refer to your policy: • • • • • ,• • • • Policy Number:97-CP-D437-8 Page 2 of 2 Prepared:December 11,2021 ©,Copyright,State Farm Mutual Automobile Insurance,Company,2008 FD-6007 • • 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 insuranceprovided under the following: s BUSINESSOWNERS COVERAGE FORM • SCHEDULE • 'Policy Number: 97-CP-D437-8 Named Insured: STRAW, DONALD E DBA FASHION FLOORS . • 90 N Mountain Ave . Ashland OR 97520-2014 • Name And Address Of Additional Insured Person Or Organization: CITY OF ASHLAND 90 N Mountain Ave Ashland OR 97520-2014 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 forthat 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 affordedthe 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-4684.1 155042 03-20-2019 ©, Copyright, State Farm Mutual Automobile Insurance Company, 20.18 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. • • • • 004561