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HomeMy WebLinkAboutInsurance Certificate: Straw Donald E. DBA Fashion FL State Farm Insurance U PO Box 2915 Bloomington, IL 61702-2915 C?CD StateFarm° AT1 000259 1200 01 .State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in'Bloomington, Illinois kit90 N MOUNTAIN AVE ASHLAND OR 97520-2014 S ; IIIIII1IIIIIIIIIIIII1li111IIIIIIIII'IIIIIIIIIIIII1IIIIII1IIIIIII .. 0)O Amended ' Declarations `, . .. ‘ .,4 Policy number:97=CP-D437-8 Effectiyle date:February 28, 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®policyperiod 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/Lien-holder written notice in compliance with thepolicy provisions or as required by law. ' NAMED INSURED . STRAW,,D,ONALD E DBA FASHION FL. ENTITY' • Sole Proprietorship-Individual -REASONS FOR DECLARATIONS • ' • Your policy is amended effective February 28, 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.!fan 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: $8.00 Discounts applied: Business Experience.Rating Renewal Discount - Protective Devices Years in Business • ' Policy number:97-CP-D437-8 • Page 1 of 6 Prepared:March 1,2022 CI Copyright, State Farm Mutual Automobile,Insurance;Company,;2008 • CMP Dec 3P OR.1' CMP-4000 1009482 2005 153090 205 08.21-2021 000989 00'tateFarm® SECTION I-PROPERTYSCHEDULE-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 - - Cov B-Consumer Price Index: 274.3 SECTION I-DEDUCTIBLES • " • BASIC DEDUCTIBLE $1,000 SPECIAL DEDUCTIBLES: ' Employee Dishonesty:. • , ,$25Q Equipment Breakdown: $1,000 f 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;:r.•, , : ; o. ., ,,- -,. .•.,,,..;;0 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 • Glass Expenses Included ' • Policy number:97-CP-0437-8 Page 2 of 6 Prepared:March 1,2022 ©Copyright, State-Farm Mutual-Autorriobile Insurance Company,.2006 . CMP-4000 ' . u . c>o StateFarme Coverage ., Limit of Insurance • 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 • E 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 . - - .'- . . . - • • 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:March 1,2022 ©,Copyright, State Farm.Mutual Automobile Insurance,Company, 2008,. , CMP-4000 000990 00 StateFarm® 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 -- - . 1;;...A;;`,•;•• , .i:i' . ".. , , '• 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 ' ' 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. • ' . . - $1.0,000 SECTION II-LOCATION SCHEDULE Location Location of described premises , , number . . . . .. _ 001 427 N RIVERSIDE AV . MEDFORD OR 97501-4602 - • 003 516SFIRST ' MEDFORD OR 97501-3616 Policy number:97-CP-D437-8 ' „ Page 4 of 6 Prepared:March 1,2022 ©Copyright, State Farm Mutual.Automobile'Insurance Company, 2008', CMP-4000 ' . U o StateFarm° SECTION II-DEDUCTIBLES •'- ,r.` Property Damage: $250 ••.; Other deductibles may apply-'refer to policy. SECTION II-LIABILITY S Coverage - Limit of Insurance , . . 8 Coverage L-Business Liability Per Occurrence' $1,000,000 Coverage M-Medical Expenses • $10,000 Any One Person • Damage to Premises.Rented b You $300,000 •. Hired Auto Liability Included in Covera9e 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: 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 1,2022 ©copyright,State'Farm Mutual Automobile Insurance Company, 2008 , CMP-4000 000991 090 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 pith 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. rn. ` • President . • Secretary • • Policy number:97-CP-D437-8 Page 6 of 6 Prepared:March 1,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2005 CMP-4000 • State Farm Insurance U. • PO Box 2915 StaFarm' Bloomington, !L 61702-29.15 t`re • State Farm Fire and Casualty Company r„ CITY OF ASHLAND .' A stock company with home offices in Bloomington, Illinois F' .90 N MOUNTAIN AVE . • .. .-. . _ ASHLAND OR 97520-2014 Nd • Inland Marine Attaching Declarations . Policy number: 97-CP-D437-8 . Effective date: February 28,2022 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 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-87431 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 1,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CIM Att Dec 3P OR.1 ' FD-6007 1009481 2002 153089 202 03.08.2021 000992 .o 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. • :f Policy number:97-CP-D437-8 Page 2 of 2 Prepared:March 1,2022 ©Copyright, State Farm Mutual Autoniobile.Insurance Company, 2006 • FD-6007