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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald (15) State Farm Insurance U PO Box 2915 e ,Bloomington,-IL 61702-2915 Oc State■ 'arm® AT1 000932 1200 01 ;State_Farm{,Fine and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois , ,4'• 90 N MOUNTAIN AVE -F. ASHLAND OR 97520-2014 • ;•N . • i. 111111lrl'jiIlIlluiiiiiiiiiIliirlIll'IIIlllhrlllll1hlj"111111 Amended Declarations •._ : ' , . „ • ,. :,.,..7)::„:,,:.;,,,„;.,...,„ ‘, .! , :,,,,,,,. i 7;t 1:t..)`' ...'-_'..i-2 Policy number:97-CP-D437-8 Effective date:May:9,2022 . ' Policy period:12 months Expiration date:February 118,2023 . The policy period begins and ends at 12:01 am standard time at the premises location, ' .• . i:;.. 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 in compliance,With the policy provisions or:as required by law. • _ . , . NAMED INSURED .,,..-,:i..!,, . IiSi:.. :': . ''... .'1 .'i, •5t : i.< ;,'.:;L:••,ici '. :yr:',Ii--.., DONALD STRAW • . ENTITY :. Sole Proprietorship-Individual '' ' ' REASONS FOR DECLARATIONS' . ' .' ; ._ • _ . _ . . _ ._ . . . Your policy is amended effective May 9,: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()shown below are forthe policy period and policy characteristics as described in this Declarations.- ' - - Decrease in premium: ($0.00) .• . - Discounts applied: r. . _- Business Experience Rating Renewal Discount 0 - Protective Devices ._ .. .Years in Business. ', • Policy number:97-CP-D437-8 Page 1,of 6 Prepared:May 12,2022 ©Copyright, State Farm:Mutual Automobile Insurance.Company 2008 -• > CMP Dec 3P OR.1 CMP-4000 1009482 2005 153090 205 08.21-2021 003687 . 0o 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 97501-4602 003 ' 516 S FIR ST 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.' . . • - 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,,. . . ,, , Accounts Receivable . -See:Schedule , Arson Reward' , $5,000 . Back-up of Sewer or Drain See Schedule ,,1,:° , ;:' •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:May 12,2022 ©Copyright,'State Farm Mutual Automobile Insurance.Company; 2008 ' CMP-4000. ' ' . u - oa StateFarm Coverage Limit of Insurance v.. • - y+ - 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' , o Money and Securities See Schedule t' coNewl Ac Acquired Business Personal Pro erty(aPPliesonl if this olicYProvides Covera e - usness $100,000 - " ' o 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:May 12,2022 ©.Copyright, State.Farm Mutual Automobile:Insurance Company, 2008 . CMP-4000 ;, nnsnnn - 090 StateFa m® 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 .. . L Back-up of Sewer.or Drain'. -_ _ s $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 f-.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 - 516SFIR ST' MEDFORD OR 97501-3616 Policy number:97-CP-D437-8 'Page 4 of 6 Prepared:May 12,2022 ©Copyright, State Farm Mutual Automobile dnsurance Company,_200S . CMP-4000 . u . : .. o State Farme SECTION II-DEDUCTIBLES k+a.. `, Property Damage: $250 , ,-- Other deductibles may apply-refer to policy, SECTION II-LIABILITY § Coverage Limit of Insurance . m. 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 i• . • 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 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:May 12,2022 ©.Copyright, State Farm Mutual Automobile Insurance Company, 2008 • . , CMP-4000 003689 090 StateFarrns 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 arid,Casualty,Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. ///ft e d 4Q7 •k President j, . Secretary, _ •3 l.� . • Policy number:97-CP-D437-8 Page'6 of 6 Prepared:May 12,2022 ©Copyright,State-Farm Mutual Automobile.Insurance Company,,2008 V CMP-4000 State Farm Insurance U PO Box 2915 . Q'J�� 6��I II/® Bloomington, !L.61702-29 i5 ' State Farm Fire,and.Casualty Company 1 CITY OF ASHLAND A stock company with home offices in- Bloomington, Illinois �' 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 S 0 c . 4y - ... .. Inland Marine Attaching Declarations . . , • . . . . . . . • . . . . Policy number: 97-CP-D437-8 Effective date: May 9, 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 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 fhe 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 12,2022 ' . ©Copyright, State Farm.Mutual Automobile Insurance Company;:2008 . CIM Att Dec 3P OR.1 . FD-60071009481 2002 153089 202 03-06.2021 • 003690 .' 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. • • . j')' ,.r • • Policy number:97-CP-D437-8 • , Page 2'of 2 Prepared:May 12,2022 • ©.Copyright, State.Farm Mutual Automobile'Insurance Company, 2008 FD-6007 . '