Loading...
HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald (07) State Farm Insurance LJ PO Box 2915090 State Farm'', Bloomington,, IL 61702-2915 AT1 000549 1200'01 _ - State Frm,Fire arid Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington;Illinois 90 N MOUNTAIN AVE ':� ASHLAND OR 97520-2014 . , S i-i rlrill111111Iiln111111ttialiiliuIIiIIIIiiilnililinuIllniliuII . Amended. Dearatibns : .., . -; .. ...,,. ..-.:_,, „.,...., . ;,- ... , r- ., ..,,, ...-,-,) :-.- Policy number:97-CP-D437-8 Effective date:May 16, 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 berenewed automatically subject;to`the premiums, rules and forms in effect for each succeedingpolicyperiod. If this policyis terminated,we willgive ou-'and the ,' • . . P . Y , Mortgagee/Lienholder written notice in compliance with the policy provisions or as required bylaw, NAMED INSURED ., DONALD STRAW, , • . • • . .. ENTITY ., . . . . Sole Proprietorship-Individual REASONS FOR DECLARATIONS ' • ' Your policy is amended effective May 16, 2022 due to some recent policy changes you requested. Enclosed is a copy'of your new endorsements, if any. .. , POLICYPREMIUM :. This is not a bill.If an amount is due,thena 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:May 16,2022 ©copyright, State..Farm,Mutual Automobile Insurance.Company,.2008, CMP Dec 3P OR.1 CMP-4000 1009482 2005 153090 205 08-21-2021, 002162 . ' . . . , . • , • , • . . . . . . , . • 090StateFarin® . . . . . . ... . .. • 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 IUnit duel° Inflation Coverage. SECTION I-INFLATION COVERAGE INDEX(ES) , • Coy A-Inflation Coverage Index: . 203.7. ., _ , . Coy B-Consumer Price Index:. . 2743 ,, ... , . , . . , . . • ., . SECTION I-DEDUCTIBLES . , . . • . BASIC DEDUCTIBLE . $1,000 SPECIAL DEDUCTIBLES: . • ,,, _;;.,1-.: ,i.,, , '..;",;,4,:•:',A, '--; Employee Dishonesty: , , - i • ,$250.. . . ,, , -. ,.,. . :. , . . , . , , . , !' . ; ., . ,.. ',f,;1- •-, Equipment Breakdown: . , $1,000, Money and Securities: ' ' '' $250 Other deductibles may apply-refer tb polibY, ' • ' ' ' ' ' ' : ' SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-EACH DESCRIBEDPREMISES 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,;;...! ,.;.‘,. A AccountsReceivable - , . , . , . . . See Schedule . , ,•.., ,. „ • . $•" ... Arson Reward $5,000 . , Back-up of Sewer or Drain • See Schedule r ., , ; •; ', Collapse' ' • ' " Included Damage to Non-owned Buildings from Theft,Burglary or Robbery , Coverage B Limit • Debris Removal 25%of covered loss ,., Equipment Breakdown Included , , • ,,. • , • , ' -•.-- • ' q • •- .. • • . 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 16,2022 CYCopyright, State Fain, Mutual Automobile Insurance Company; 2006 . . ,. . CA/fp-4060' , . .. . , U. . • a&StateFarma Coverage Limit of Insurance . % •...Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a„ 10%•- - • c replacement cost basis) Money Orders and Counterfeit Money $1,000 ,, • Money and Securities See Schedule. + g - o 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 Prpperty •- - • - • - 30 days - Property of Others(applies onlyito 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 - r,: :, .„ ' ' 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 0 Policy number:97-CP-D437-8 I 'Page 3 of 6 Prepared:May 16,2022 ©Copyright, State Farm,Mutual Automobile Insurance Company,,2008 , • CMP-4000 awl RI . , . . 090 State Farina , . Location , Coverage `: - Limit of Insurance number • . ,... • . ..... — _ . •_ •. •• ..• ... ._ • . .... • , .. ' - ,.. •• 4, , • 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 - , Outdoor Property . ' ' -- ' $5,000 • . Property of Others(applies only to those premises provided Coverage • $2,500 . . B-Business Personal'Property) ' ' , ., `.-- - ' ' -.• •< . :. , . Signs V $5,000- - . - . .. - • Valuable Papers and Records . . . - ' , V . • , - , On Premises Limit , . - - - -. $10,000 - , ... Off Premises Limit - - .- • -- - • • $5,000 7, •;:,:,-,-",V,,.1.. •.... ,';'"°-- JU '2 :'.'' '•Vr ' -:;:):','. '11r... 0',• - '", ' ' ' " , ! -'- SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF IllgiRANQE-PER POLICY .. The coverages and corresponding limits shown below are the Most we will pay regardleSeOf the number of deecribed premises shown in these Declarations. Coverage - - ' - •• ` - - • - •• -- ' ' - -Limit of Insurance Dependent Property-Loss of Income - - - -- $5,000 V 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 .. V • • 001 . 427 N RWERSIDE AV . . - . MEDFORD OR 97501-4602 ..... - ,. ' - . .. . _ • 003 - 516 S FIR ST ' ' - . V V V " MEDFORD OR 97501-3616 -V _ ... ... .. .. . Policy number:97-CP-D437-8 • Page 4 of 8 Prepared:May 16,2022 -©CdpiyrightiState Faim Mutial Automobile Insurance-Coi-npany, 2008 ..- CMP-400D , . „ u ' S .� StateFarmm SECTION II-DEDUCTIBLES V-- Property Damage: $250 . - Other deductibles may apply-refer to policy. SECTION II-LIABILITY , qo Coverage Limit of Insurance . ' $ Coverage L-Business Liability Per Occurrence $1,000,000 no 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. Pleaserefer 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 16,2022 ©Copyright,,State Farm;MutualAutomobile Insurance Company, 2008., . , CMP-4000 . 002164 • • • 0o Stat eFarm' 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 I'ncorpor'ation, 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. /14 e + 11iJQ, 414.410, 1d6Aikfit° President Secretary • • . • • • • • • • Policy number:97-CP-D437-8Page 6 of 6 Prepared:May 16;2022 ©Copyright; State farm'Mutual Autbmbbile Insurande Company,:2008 CMP-4000 State Farm Insurance • U PO Box 2915 Bloomington, IL 61702-2915 .Q StateFarm® State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home office's in Bloomington, 'Illinois 21 90 N MOUNTAIN AVE. _ _. .. . . ASHLAND OR 97520-2014 0 O -o Inland Marine Attaching Declarations ' Policy number: 97-CP=D437-8 Effective date: May 16, 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 andendorsements 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-D437-6 . . , Page 1 of 2 • Prepared:May 16,2022 ©Copyright, State Farm Mutual Automobile Insurance Company,.2008• CIM Att Dec 3P OR.1 , FD-6007 1009461 2002 153089 202 03-06-2021 002165 a0 State • 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. aLw • Policy number:97-CP-D437-8 Page 2.of 2 Prepared:May 16,2022 ©Copyright, State Farm Mutual'Automobile'lrsurance Company', 2008 ' . FD-6007