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HomeMy WebLinkAboutInsurance Certificate: Straw, Donald State Farm Insurance LJ PO Box 2915 . ,, Bloomington, IL 61702-2915 CTO State Farm! AT1 000281 1200 01 .. ;State State Farm:Fire,and Casualty;Company 4 CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois - ' .4. 90 N MOUNTAIN AVE ' :'4'i ' ASHLAND OR 97520-2014 • f, , s = . II ilii I I I. I. it ilnl n �I 1 II I� i '� - , V .__ -- ... _. - �$ it I I III I IIIII Ir Intl III I I tl a it Ilii �� � �� - • } Amended- Declarations , i„,,7 .i 7_ 1 .1"" - (P :)_,•,,.:, ' thy ii. . . Policy number:97-CP-D437-8 Effective.date:May 11, 2022 ' ' ' Policy period: 12 months Expiration date:February 1;8,2023 The policy period begins and ends at 12:01 am standard time at the premises location. ....;_„•,,'•.,:.: :.i,, ,':. ,,y 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 ' Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. NAMED INSURED ., . ''''f'1' ;' ',i.5:.,_ . ,...'!i"„! ,:: l_,,, -, )k;:-. - .....,: , .. „ ,- DONALD STRAW. V ENTITY . Sole Proprietorship-Individual REASONS-FOR DECLARATIONS ' ✓ ” ., .. Your policy.is amended effective May 11, 2022 due to some recent policy changes you requested. Enclosed is,a copy of your'-new endorsements, if any. v. , . , 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; ' Increase in premium: $13.00 - - • - - - • Discounts applied: V . Business Experience Rating ' V -- Renewal Discount , - ' .- Protective Devices . . . Years in Business . Policy number:97-CP-D437-8 Page 1 of 6 Prepared:May 11,2022 ©.Copyright; State;.Farm Mutual,Automobile Insurance Company,,:2008 CMP Dec 3P OR.1 V - CMP-4000 1009482 2005 153090 205 08-21-2021 001083 ' State Farina' 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% 0 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: i<,^'< "1 Employee Dishonesty: •$250: r 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 corresponding limits shown below apply separately to each described premises shown in these'Declarations, unless indicated by"See schedule". If a coveragedoes not have a corresponding limit shown below, but has"Included" indicatedrrefer 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 a- • - ., 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:May 11,2022 ©Copyright, State:Farm Mutual Automobile'Insurance Company, 2006' • ' CMP-4000- '. •. • LI . oo StateFarm Coverage Limit of Insurance . 1 f� 1t Increased.Cost of Construction and Demolition Costs(applies only when buildings are insured on a- - 10% • • - .. . '}z"t replacement cost basis) • Money Orders and Counterfeit Money ),,' $1,000 S Money and Securities See Schedule ': - Ic75 P.'$ 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 7 :i.'I• i' .,. .. .;1. y 'n=t":', , 'x'11. :1-: The - The coverages and corresponding limits shown below apply only,to the described,prernises as shown. , Location Coverage Limit of Insurance number ' . 001 - • Accounts Receivable • • • ' . , ' - '- - • - • • - • -.- - - • On Premises Limit - - ' • - $10,000 - OffPremises 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 0 . Property of Others(applies only to those premises provided Coverage • $2,500 , • ,,. 1 . B-Business Personal Property) , • Signs' • $5,000 ' ' •Policy number:97-CP-D437-8 .Page 3 of 6 , Prepared:May 11,2022 . ©Copyright,'State:Farm'Mutuaf'Automobile Insurance Company, 2008. CMP-4000 ' 001084 ' . . , - co StateFarm® Location Coverage Limit of Insurance ' number". - - • _ . . _ _, - .. ..,. , _ . _ - Valuable Papers and Records . . . • On Premises Limit • , $10,000 Off PremisesLimit - $5,000 • 003 Accounts Receivable , , , On Premises Limit .. . . - .- _ - $10,000:.. . . . . _ . - Off Premises Limit- _ -t.- $5,000 - Back-up of.Sewer or,Drain ... ..$15,000 , .. . . . Money and-Securities On Premises Limit $10,000 . - Off Premises Limit . . . . .. _$5,000 '. - OutdoorProperty $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 riuniber of described prerriises shown in these Declarations, - -Coverage ' 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 describedpremises number ' 001 427 N RIVERSIDE AV ' MEDFORD OR 97501-4602 - 003 516SFIR ST -y - MEDFORD OR 97501-3616 • . - - - - --- ' - - - Policy number:97-CP-D437-8 ' Page 4 of 6 Prepared:May 11,2022 •©Copyright, State,Farm Mutual-Automobile lnsurance•Company, 2008 ' ' CMP-4000 ' • . u : . G State Farina' SECTION II-DEDUCTIBLES "J1 Property Damage: $250 {•••+'' Other deductibles may apply-refer'to policy, SECTION II-LIABILITY • § Coverage . Limit.of Insurance, . • 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 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 BU.SINESSOWNERS 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:May 11.2022 ©.Copyright; State Farm Mutual Automobile Insurance Company,.2008 , CMP-4000 . nninac 0 o StatèFam® 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 Incorporation, as amended, In Witness Whereof, the State Farm•Fire and Casualty Company has caused this policy to be signed by ifs President'and Secretary at Bloomington, Illinois. *pt4tt, I ►I,• - President Secretary • _ • • • Policy number;97-CP-D437-6 Page 6 of 6 Prepared:May 11,2022 ©Copyright, State.Farm'Mutual Automobile Insurance Company;2008 CMP-4000 State.Farm Insurance LJ PO Bonto , O090 State (rill �' -Bloomingtonn,`!L`61702-2975 • State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois • 90 N•MOUNTAIN AVE ASHLAND OR 97520-2014 C O '6E • Inland Marine Attaching Declarations Policy number: 97-CP-D437-8 • Effective date: May 11, 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, rulesand forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the MortgageeiLienholder 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:May 11,2022 ©"Copyright,State,Farm Mutual Automobile lInsurance Company,.2008 CIM Att Dec 3P OR.1 FD-6007 1009481 2002 153069 202 03-06-2021 • • . CFO State Farm® 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 ininsureds 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, - . • • ...,,i,�...._,..t:.. _. .:.,;. ..,`....:4. _psi • • Policy number:97-CP-D437-8 Page 2.of 2 Prepared:May 11,2022 • ©Copyright,.State Farm,Mutual Automobile,Insurance',Company, 2008 • U FD-6007 .. , • , •