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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald (12) State Farm Insurance 11 PO Box 2915 • Bloomington, IL 61702:2915 OPO State Farm® - • ., .. _ _ . All 000184 1200 01 • . , , „State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with hothe offices in'Bidom'ingtoh, IllinoiS -90 N MOUNTAIN AVE 1;c - ASHLAND OR 97520-2014 . ., . - , . . • • . ..2 iiiii11.11111111111111111111.11111111111111111110111111111111[11 .. , . . . . . , , . , . . . . , . . Amended Declarations.2' . : , -, - : - , . •-•, -. -, '..- - - ' - • • , .- -- . - . Policy number:97-CP-D437-8 . ' Effective date:Mach 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. . . ._ . 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 --- — - - • _ Mottgeoie/Liehholder written'n-Ctice--in-cbt CliahOe with the policy ptyi6iOns"b-r-"aq tquifia"pylacf. -' "-- , . . . . . NAMED INSURED ' . DONALD STRAW , . , . ENTITY - . ., -. . , . .. . . Sole Proprietorship-Individual • REASONS FOR DECLARATIONS . .' ' :: _ : . Your policy is amended effective March 18; 2022 due to.some recent policy changes you requested. Enclosed is a Copy of your-new endorsements, if any. . . .. ,• . . . . - - • . - . . . -- - . POLICY PREMIUM ,• .. -. :• . This is nota 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: $14.00 . . . . , - Discounti applied: . .• . . Business Experience Rating - Renewal Discount . . , s . , • Protective Devices Years in Business • . . . . . . , , . . • Policy number:97-CP-D437-8 , Page 1 of 6 Prepared:March 21,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 • CMP Dec 312 OR.1 CMP-4000 ' 1009482 2005 153090 205 08.21-2021. 000709 o&StateFarm® 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 975014602 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) Cov A-Inflation Coverage Index: 203.7 Coy B•Consumer Price Index: 274.3 SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE. $1,000 SPECIAL DEDUCTIBLES: Employee'Dishonesty,: . • . ;$250 Equipment Breakdown: $1,000 . Money and Securities: ' $250 Other deductibles may apply- refer to policy. 0 ' ' 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: r, „ .. 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 0 Included Fire Department Service Charge $2,500. `. Fire Extinguisher Systems Recharge Expense 0 ' $5,000 Forgery or Alteration $10,000 Glass Expenses Included Policy number:97-CP-D437-8 Page 2 of 6 Prepared:March 21,2022 ©Copyright, State Farm Mutuel`Automobile Insurance Company,'2008 CMP-4000 LI • • . . . 09 StateFarmo Coverage ,3 .Limit of Insurance 8`• Increased Cost of Construction and Demolition.Costs(applies only when buildings,are insured on a. . 10%- .ftllr.1, replacement cost basis) , Money Orders and Counterfeit Money $1,000 • . , . ' § Money and Securities , .. See Schedule 0 In 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 r 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 . . . •. • • ' 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 ' V $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 . • i Page 3 of 6 Prepared:March 21,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 • • • CMP-4000 000710 oa State Farm® 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 orDrain - •$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- - - • - - • 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 ' ' ' ' - ' Limit of Insurance • 0 -.. -' 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 001427 N RIVERSIDE AV . . MEDFORD OR 97501-4602 • 003 516 S FIRST MEDFORD OR 97501-3616'- ' - ' ' Policy number:97-CP-D437-8 ' .• Page 4 of 6 Prepared:March 21,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2005 CMP-4000 ' Li • 00 StateFarni SECTION II-DEDUCTIBLES , . Rilg Property Damage: $250 . Other deductibles may apply-refer to policy, • .. '.1. t SECTION II-LIABILITY . § Coverage • .Limit of Insurance Iji o Coverage L-Business Liability Per Occurrence $1,000,000 Coverage M-Medical Expenses $10,000 Any One Person Damage to Premises Rented to Your. $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 provideduring 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: N/A CITY OF ASHLAND 90 N Mountain Ave Ashland OR 97520-2014 FULL NAMED INSURED Policy number:97-CP-D437-8 Page 5 of 6- Prepared:March 21,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2005 GMP-4000 , 000711 090 State Farm' Named Insured: DONALD E STRAW 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 I icorporation '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. ,f/i i. • rn . President �'✓�/ Secretary , • • • • • Policy number:97-CP-D437-8 Page 6 of 6 • Prepared:March 21,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008' CMP-4000 . State Farm Insurance U PO Box 2915 Q c /� Bloomington,.IL 61702-2915 • A Sfatel drm State Farm Fire and Casualty Company CITY OF ASHLAND ' ' A stock company with home offices in Bloomington, Illinois 90 N MOUNTAIN.AVE .- .- . 'r2- ' ASHLAND OR 97520-2014 .. '. 6-i . • Inland Marine Attaching • Declarations . — Policy number: 97-CP-D437-8 Effective date: March 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 MortgageelLienholder 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: DONALD 'E STRAW 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:March 21,2022 ©Copyright,State Farm Mutual Automobile_Insurance Company, 2008 . CIM Att Dec 3P OR.1 FD-6007 1009481 2002 183088 202 03-06-2021 • 000712 0 o'StateFarm® 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. • • • • • •• ..1;1115 ! _ , .. F,a ifs. I' .-•.n ;1,. ! • • Policy number:97-CP-D437-8 Page 2 of 2 Prepared:March 21,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007