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HomeMy WebLinkAboutInsurance Certificate: Ashland Food Angels State Farm Insurance U PO Boxo StateFarnr Bloomingtton,, IL 61702-29 O% .15 `r AT2 001068 1200 01 State Farm Fire.and:Casualty tCompany CITY OF ASHLAND ITS OFFICERS& A stock company with home offices in Bloorriington, Illinois raj20EMAIN ST • • ASHLAND OR 97520-1814 .. S 0 �o 1111111111111'111111'111111111111114111111111"11111111.1111111 . Renewal Declarations _.. , , . , .. Policy number:97-AA-C018-4 Effective date:July,29, 2022 Policy period:12 months Expiration date:July 29, 2023 The policy period begins and ends at 12:01 am standard time at the premises location. . BUSINESSOWNERS POLICY • Automatic renewal-If the State,Farm®policy period is shown as 12 months, this policy willbe 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 policyyprovisions or as required bylaw, - NAMED INSURED • - - - ASHLAND FOOD ANGELS- . - - . . ENTITY - Nonprofit . IMPORTANTMESSAGE(S) . • Notice -Informationconcerning changes in your policy language is included. Please call your agent if you have any questions. POLICYPREMIUM . 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: $465.00. , Total Premium: $465.00 V - . . - Minimum Premium ' Discounts applied.: .' - -. - Business Experience Rating Renewal Discount . • Protective Devices Years.in Business • , - -. . - . • Policy number:97-AA-C018-4 Page,1 of 5 Prepared:May 21,2022 ©Copyright, State Farm Mutual Automobile Insurance Company,,2008 . CMPDec 3P OR.1 CMP-4000 1009462 2005 153090 205 08.21-2021 004596 QoStat eFarm° 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 001 472 WALKER AVE No Coverage, $11,300 25% , ASHLAND OR 97520-2324 *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: N/A Coy B-Consumer Price Index: 283.7 • SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE $1,000 SPECIAL DEDUCTIBLES: . . 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 ' Limitof Insurance Accounts Receivable . . • On Premises - $10,000 . Off Premises $5,000 Arson Reward $5,000 , Collapse .' . Included Damage to Non-owned Buildings from Theft,Burglary or RobberyCoverage B Limit Debris Removal25%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 . _ . . , 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 . Policy number:97-AA-0018-4 v Page 2 of 5 Prepared:May 21,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 - CMP-4000 • U 090 StateFarm. • _ . . Coverage Limit of Insurance ugp.. Money and Securities . . •. On Premises • , . ' $5,000 . Off Premises $2,0000 Newly Acquired Business Personal Property(applies onlY if this policy provides Coverage B-Business $100,000 , I-CV 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) ,$2,500. " • 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 . - Valuable Papers and Records On Premises . $10,000 . .• Off Premises • . $5,000 . . . , Water Damage, Other Liquids,Powder or Molten Material Damage Included, . - - - 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 • Loss of Income and Extra Expense 12 Months Actual Loss Sustained , SECTION II-LOCATION SCHEDULE „ - Location •• Location of described premises - s „ ' , , • number. 001 472 WALKER AVE ' ASHLAND OR 97520-2324 ;.• , " ° • • Policy number:97-AA-0018-4 Page 3 of 5 Prepared:May 21,2022 ©,Copyright, State Farm Mutual Automobile-Insurance Company, 2006 CMP-4000 004597 Qo StateFarm® SECTION II-LIABILITY • Coverage Limit of Insurance . Coverage L-Business Liability Per Occurrence $1,000,000 Coverage M-Medical Expenses • $5,000 Any One Person Damage to Premises Rented to You ,• • , . $300,000; ' •' . • ' -. .- . , • , •. 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. •- V - - - V 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-4705.2 ' Loss of Income and Extra Expense ' V V CMP-4709 Money and Securities , ' CMP-4798 Additional Insured-Grantor of Franchise . • - '• . . - 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) . . . V , Interest type: Grantor of Franchise -,•,,:.:::-..q _ :•, , ,<r; .,j a . .r.--;•-••••-:'. Endorsement Endorsement number: CMP-4798 Loan number: N/A ' - V • CITY OF ASHLAND ITS OFFICERS&EMPLOYEES • 20 E Main St Ashland OR 97520-1 B14 . This policy is issued the State Farm Fire and Casualty Company. . . . .. ° . . - PARTICIPATING POLICY . ' '. ' ,,v,fl.i " - You are entitled to participate in a distribution of the earnings of the company as determined by o ur`Board.df-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. . . . .. .. V ." . , ,gam ., rn • President • Secretary Policy number:97-AA-C018-4 Page 4 of 5 Prepared:May 21,2022 ©Copyright, State Farm Mutual'Automoblle-Insurance Company, 2008 • CMP-4000 • . - Statefarme OTHER MESSAGE(S) 4,6 NOTICE TO POLICYHOLDER: Fora 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 s unless otherwise indicated by;a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice N are also effective on the Renewal Date of this policy. Policy changes requested after the"bate.Prepared"will be sent to you as an,amended declarations 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 coat 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 agent and to notify us of any changes or additions to your structure. • • • • • Policy number:97-AA-C018-4 Page 5 of 5 Prepared:May 21,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP'44000 - 004598 • State Farm Insurance U PO Box 2915 Bloomington, IL 61702-2915 090 StateFarnr• • • • State Farm Fire and Casualty Company CITY OF ASHLAND ITS OFFICERS& .A stock company with home offices in Bloomington, Illinois 20 E MAIN ST ;4) ASHLAND OR 97520-1814 • • •S CO • • lnland ' Marine Attaching Declarations • • • • Policy number: 97-AA-C018-4 Effective date: July 29, 2022 Policy period: 12,months . ' Expiration date: July 29, 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 thei 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 Fomi $25,000 $500 Included • Lpss of.Income and Extra Expense . ' $25,000 Included Other limits and exclusion's may apply-refer to your policy. Policy number:97-AA-C018-4 Page 1 of 1 Prepared:May 21,2022 ©Copyright, State Farm MutUal Automobile Insurance Company, 2008 CIM Att Dec 3P OR.1 FD-6007 1009481 2002 153089 202 03-06-2021 004599 • ' ' ' u CMP-4798 Pagel of1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.. • • '• Y'` ADDITIONAL INSURED—GRANTOR OF FRANCHISE This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM • 1—in • SCHEDULE • Policy Number: 97-AA-C018-4 Named Insured: ASHLAND FOOD ANGELS Name And Address Of Additional Insured'Person Or Organization: . CITY OF ASHLAND ITS OFFICERS &EMPLOYEES • 20EMain 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 with respect to their liability as grantor of a franchise to you. 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-4798 151377 06-02-2017 ©, Copyright, State Farm Mutual Automobile Insurance Company,'2008 Includes copyrighted material of Insurance Services Office, Inc.,with Its permission. 004600 , '