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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald (13) State Farm Insurance U PO Box 2915 /� ,Bloomington, IL_ 61702-2915 OO State Farme AT1 000512 1200 01 . , ,.State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington,Illinois 90 N MOUNTAIN AVE • G'-' ASHLAND OR 97520-2014 . • S . • _, r I Ir nrl I II i i ill I n i l Illlul r i- Inl III II I I I IIIIIIII I nl II IIII I I Ili I Amended Declarations - ' . - . .. - . . . . ,„•,F, :,:, ' •,:,. . _.'• - ••,i :.. -.;',:l .-: Policy number:97-CP-D437-8 • Effectiye date:April 20, 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•• . " . " _ . . _- -MortgageelLienholder written notice•ln compliance with the policy provisions or as required.by,law. , " , NAMED INSURED . DONALD_STRAW . • • . , .. , .ENTITY . . , • . Sole Proprietorship-Individual : REASONS FOR DECLARATIONS .' . . • Your policy is amended effective April 20, 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 prior to the due;date. The premium(s)shown below are for the policy period and policy characteristics as described in this Declarations. . • . • Change in premium: none . ' . . • . Discounts applied: , Business Experience Rating Renewal Discount • - ' • Protective Devices .Years in Business . • Policy number:97-CP-D437-8 • . Page 1 of 6 ' Prepared:April 20,2022 ©Copyright,.State Farm Mutual Automobile Insurance Company, 2008 , CMP Dec 3P OR.1 CMP-4000 1009482 2005 153090 205 08.21-2021 002055 ooStateFarrne 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 SPECIALDEDUCTIBLES: - 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, AQ,H 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 Glass Expenses Included Policy number:97-CP-D437-8 Page 2 of 6 Prepared:'April 20,2022 ©Copyright, State Farm Mutual:Automobile Insurance Company,'2008 CMP-4000' LI 0 State Farme Coverage • • Limit of Insurance Nt. • 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 •0 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 . - . • • On Premises Limit $10,000 • • S 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:April 20,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 002056 • oo StateFarm® Location Coverage Limit of Insurance riumber • ' _ . • .. - . 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 • - - BBusiness 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 - 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 N RIVERSIDE AV . . • MEDFORD OR 97501-4602 • • 003 516 SFIRST • 'MEDFORD OR 97501-3616 ' ,.Policy number:97-CP-D437-8 Page 4 of 6 Prepared:April 20,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 - u Qo State Fame SECTION II-DEDUCTIBLES , ,0 Property Damage: $250 . •• , ;.4 in. Other deductibles may apply-refer to policy. • SECTION II-LIABILITY 8 Coverage Limit of Insurance co. 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 Coverage t , 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:April 20,2022 ©Copyright, State Farm Mutual Automobile Insurance Company,,2005 CMP-4000 002057 00 State Farme Named Insured: DONALD E STRAW DBA FASHION FLOORS This policy is issued by the State Farm Fire and Casualty Company. . PARTICIPATING POLICY • ec' Youare 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. • iffteL64-Q:777-4etto-0 President . . . Secretary • • • • • Policy number:97-CP-D437-8 Page 6 of 6 Prepared:April 20,2022 ©Copyright, State Farm Mutual Autorhobile"Insurance Company, 2006 CMP-4000 State Farm Insurance LJ • • • PO Box 2915 C°C State■arm Bloommingtton,,:!L 61702-2915, State Farm Fire and Casualty Company CITY OF ASHLAND .. . ' . ` ' • A stock company with home offices in Bloomington, Illinois 90 N MOUNTAIN AVE . . . . . --0,N - ' . ASHLAND OR 97520-2014 . . O �a Inland Marine A.ttach.ing ,,Declarauons , . . Policy number: 97-CP-D437-8 Effective date:April 20,2022 . 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: 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 V 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 PAG ' • Endorsement Coverage V ' Limit of insurance Deductible amount Annual premium' number • • FE-8743.1 Inland Marine.Computer Property Form V $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:April20,2022 ©Copyright, State'Farm Mutual.Automobile Insurance Company„2005 - CIM Att Dec 3P OR.1 FD-6007 ' 1009451 2002 153069 202 03.05-2021 002058 Q Q JtateFarm® 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:April 20,2022 Q Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007