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HomeMy WebLinkAboutInsurance Certificate: Cascade Charter Co. State Farm Insurance u PO Box 2915 Bloomington, IL ,61702-2915 090 State Farm@ . . . . . AT2 002910 1200 01 Statefarm ire and,Casualty,company _ .. . . . .,. CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois RN . .20 E MAIN ST"Th . ASHLAND OR 97520-1614 . " ' " • - - - - _ _ • . . - . . . . . .. _ ' — - . , . . § i , 111111111111'llill'111116111.111"11111104141111.1111i111111,111 :, . . . . , . . .. . . . ., (00 . • . . , . • ,--. • • , , , ., . .. , • , • , „ . . • E. • Renewal •Declarations ., . , , .... , . • • .. . • . . Policy number:97-CP-R296-3 Effective date;April 1,2022 . . . . ,. . Policy period: 12 months Expiration date:April 1, 2023 . . , • . . The policy period begins and ends at 12:01 am standard time at the premises location. .. . OFFICE POLICY Automate renewal -If the'State.Farm®polio/'period is shown as 12 months, this policy4ill 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.'ancl.the'. - . ' • - - ,', --7. • __Mortgagee/Lienholder-written notiCO:in-compliance with the plicy Provisions or as required•bY law: . ‘ . NAMED INSURED ' . . • . . . . . .. _ . . .. . • , . . CASCADE CHARTER COMPANY, LLC . . . . • . . . . - - - ENTITY . . . . • • . . • • ' . • • . . . Limited Liability Company . S . . . IMPORTANT mE .'gsAGE(s) ., - , Notice -Information concerning changps,in your policy language is included. Please call your agent if you have any questions. , . 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 is the 12 months premium(s)for the characteristics of the policy as described in this Declarations. , , . Premium: $881.00 5 . Total Premium: $881.00 :- -. .... • Discounts applied: . • • " , , .. . ... . . . Business Experience Rating ' , ' Renewal Discount 0 . ' . , . .. . Years in Business . . . • . . .' . . . • ' - • „ . • . . . . , . . • . . . Policy number:97-CP-R296-3 . . .Page 1 of 5 Prepared:January 22,2022 ©Copyright, State Farm Mutual Automobile Insurance Company,2 .008 CMP Dec 3P OR.1 0 0 . . CMP-4000 1009482 2005 153090 205 08-21-2021 012889 o 5tafeFarirn® SECTION I-PROPERTY SCHEDULE " , . Location Location of described premises Limit of Insurance* Limit of Insurance* Seasonal Increase- number Coverage A- Coverage B-Business. .Business,Personal Property- • . Buildings Personal Property • 001 • 2800 BIDDLE RD $535,100 • $39,200 25% MEDFORD OR 97504-4115 • *As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the liimit'due to Inflation Coverage. • SECTION I—INFLATION COVERAGE INDEX(ES) . . Coy A-Inflation Coverage Index: 207 Cov'B-Consumer Price Index: 276.6 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. SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-EACH DESCRIBED PREMISES . The coverages and.cprresponding 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 cover•age.. . . , Coverage • Limit of Insurance ; Accounts Receivable _ - • On Premises • $50,000 Off Premises $15,000 , •Arson Reward $5,000 • .• • • Back-up of Sewer'or Drain $15,000 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 . ' $5,000 Fire Extinguisher Systems Recharge Expense •. . - . $5,000 • , , Forgery or Alteration $10,000 Glass Expenses Included • Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a 10% replacement cost basis) Policy number:97-CP-R296-3 Page 2 of 5 Prepared:January 22,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-400D • oa StateFarm° Coverage Limit of Insurance • r. '1 •' -,.•-1- FLA Money Orders and Counterfeit Money $1,000 Money and Securities -- - • On Premises • . $10,000 • 0 O Off Premises - • $5,000 ' . - - • 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 $5,000 Personal Effects(applies only to those premises provided Coverage B-Business Personal Property) ..$5,000 • Personal Property Off-Premises - - - -- --$15,000- - -• • • 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 $2,500 • Property) Signs $2;500 Unauthorized Business Card Use $5,000 Valuable Papers and Records . On Premises $50,000- , " ' , Off Premises - $15,000 : ' ' - Water Damage; Other Liquids,Powder or Molten Material Dainage .. ' . Included ' ` ' . SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY The coverages and corresponding limits shown below are the most we will pay regardles's 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 Sustairied:p•` ; -+.• l" Utility Interruption-Loss of Income , ' $10,000 • Policy number:97-CP-R296-3 Page 3 of 5 Prepared:January 22,2022 ©Copyright, State.Farm Mutual Automobile Insurance Company, 2008 CMP-4000 • 012890 ' oQ State Farme SECTION II-LOCATION SCHEDULE.,. .� Location Location of described prernises . number - 001 2800 BIDDLE RD . • ' . MEDFORD OR 97504-4115 . . - ..... SECTION II-LIABILITY , Coverage Limit of Insurance ' Coverage L Business Liability Per Occurrence' $2,000,000 ' ' ' •• Coverage M-Medical Expenses $10,000 Any One Person - Damage to Premises Rented to You $300,000 Aggregate Limits - Limit of Insurance - General Aggregate $4,000,000 - Products/Completed Operations Aggregate . .. . . $4,000,000 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 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-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-4767 Waiver of Transfer of Rights of Recovery Against Others To Us CMP-4819.1 . Unauthorized Business Card Use .. , . , . . . ..._.. . _ 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 20 E Main St Ashland OR 97520-1814 • Policy number:97-CP-R296-3 Page 4 of 5 Prepared:January 22,2022 ©Copyright, State Farm Mutual Automobile Insurance-Company,•2008 CMP-4000 u o StateFarm. This policy is issued by the State Farm Fire and Casualty Company. PARTICIPATING PQ! ICY 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 j Bloomington, Illinois. President Secretary OTHER MESSAGES) NOTICE TO POLICYHOLDER: For a 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, bindr, 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 amendeddeclarations 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 a coverage 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 your structure. 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.agentand..to..notify-us of.any.changes.or additions to your structure. • Policy number:97-CP-R296-3 Page 5 of 5 Prepared:January 22,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 . 012891 State Farm Insurance . PO Box 2915 c Bloomington, IL 61702-2915 O.O StateFarmo State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 20 E MAIN ST " • ASHLAND OR 97520-1814 • S • Inland Marine Attaching..DecIarations . Policy number: 97-CP-R296-3 Effective date:April 1, 2022 Policy period: 12 months Expiration date:April 1, 2023 The policy period begins and ends at 12:01 am standard time at the premises location. • • ATTACHING INLAND MARINE 0 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: Included The above premium amount is included in the Policy Premium shown on the Declarations. 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. 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. Other limits and exclusions may apply-refer to your policy. • Policy number:97-CP-R296-3 • • Page 1 of 1 Prepared:January 22,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CIM At Dec 3P OR.1 FD-6007 1009461 2002 153069 202 03-06-2021 012892 u CMP-4684.1 Page 1 of THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED —OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: s BUSINESSOWNERS COVERAGE FORM 1-6o SCHEDULE Policy Number: 97-CP-R296-3 Named Insured: CASCADE CHARTER COMPANY, LLC 2800 Biddle Rd Medford OR 97504-4115 • Name And Address Of Additional Insured Person Or Organization: CITY OF ASHLAND 20 E Main St Ashland OR 97520-1814 • 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 for that 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 afforded the 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 • ©,Copyright, State Farm Mutual Automobile Insurance Company, 201 B • Includes copyrighted material of Insurance Services Office,Inc.,with its permission. • 012893