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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald (16) State Farm Insurance PO Box 29150° StateFarm& 'Bloomington,,•!L 61702=2915 AT1 000725. 1200 01 • :,, •State Farm.Fire.and Casualt .Com a CITY OF ASHLAND A stock company with home offices in Bloomington,IlphO 90 N MOUNTAIN AVE ASHLAND.OR 97520-2014 • • • 0 "IIII'llll'II'll'III'IIuLrIIIIIIIIIII"IIIIIIIIIIIIIII'I'IIIII A.. ArnendedDeclaration:s ,:.,, :`. :`_',! �:.. ,., i,;''t.•:.G'i 1'c. ;-.• Policy number:97-CP-D437-8 Effective date:August 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. • _ • • 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 foreach succeeding policy period. if this policy is terminated, we will give you and,the MortgageelLienholder'written notice incompliance`with the policy provisions oras required by law, NAMED INSURED,• DONALD STRAW ENTITY Sole Proprietorship-Individual REASONS FOR DECLARATIONS . Your policy is amended.effective August 11; 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. - Increase in premium: $25.00 - " . Discounts applied:. Business Experience Rating Renewal Discount Protective Devices • - Years in.Business. ' Policy number:97-CP-0437-8 Page 1 of 6 Prepared:August 17,2022 ©„Copyright;State,Farm Mutual Automobile insurance Company, 2005 CMP Dec 3P OR.1 CMP-4000 1009482 2006 153090 206 08-21.2021, 002878 ” • '09StateFarme SECTION I YPROPERTY 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 • CovB-Consumer Price Index: 2743 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 j,••a , ;; Accounts Receivable , See Schedule Arson Reward $5,000 Back-up of Sewer or Drain See Schedule i,:"0.;"• 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:August 17,2022 ©Copyright, State Farrri Mutual Automobile•I`nsuVarice:Company,'2008 cup-4000 L.., 090 StateFarm® • Coverage . . • Limit of Insurance , l'i•,1., 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 ... • • 8 Money and Securities - • See Schedule 1-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-6-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(appliesonly 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:August 17,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, -2008 CMP-4000 • • 002879 . 090 StateFarm® Location Coverage Limit of Insurance number - - _ . .. . . - - - - Valuable Papers and Records •• On Premises Limit $10,000 .• Off Premises Limit • $5,000 .. , .. 003 Accounts Receivable . , • ' -V, , • . ' ....1, • 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 - V - • Outdoor Property • - - .• . . $5,000 -- . - • • -Property of Others(applies only to those premises provided Coverage V $2,500 - •- B-Business Personal Property) . - . • Signs -• • $5,000 - -- V Valuable Papers and Records . •-- • • - . - • On Premises Limit - - $10,000 - • - - • Off Premises-Limit. - - - - • • - $5,000 - ;, u'-.i. ,.r ,'q.•: 'i i -.: oil f'•.•1..;:f ,(l,i'I. ' , . !'-,7T- '\'. SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY The coverages and corresponding limits shown below are the most we will'pay regardl`e"ss of the number of described premises shown in these Declarations. • Coverage - - .• , . • • • - • •• ' Limit'of•lnsurance • • • - -- - - - .- -- Dependent Property-Loss of Income .. v $5,000 - Employee Dishonesty - - • • , $10,000 - V. 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:August 17,2022 ©Copyright,'State'Farm Mutual Automobile Insurance Company,'2008 • GMP-4000 u • • & StateFarm® SECTION H-DEDUCTIBLES �, Property Damage: $250 • Other deductibles may apply=refer to policy, SECTION Il-LIABILITY 8 Coverage • Limit of Insurance, y$ Coverage L Business Liability Per Occurrence • $1,000,000 Coverage M-Medical Expenses $10,000 Any One Persbn , -: . Damage to Premises Rented to You $300,000 _ • Hired Auto LiabilityIncluded 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 or 6 Prepared:August 17,2022• • ©Copyright, State Farm-Mutual Automobile,Insurance Company,42006 : , CMP-4000 . • ' 002880 • • 090 StateFarone • J�:� •fir+• .i:iI t i i...T.. 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 tha 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:. • President Secretary • • ' . . •11', :{u: • • • • • • Policy number:97-CP-D437-8 Page 6 of 6' Prepared:August 17,2022 ©Copyright, State. Farm•Mutual Automobile lrisurance Compariy, 2008 • ' CMP-4000 ' LJ State Farm Insurance PO Box 2915 Bloomington, IL-61.702-2915 • CFO StateFarme 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 • e . O 0,o • Inland . Marine Attaching Declarations . ' , . • . . . . . 'Policy number: 97-CP-D437-8 - Effective date:,August 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, 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 • 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 ' ' ' ' I_ Page 1 of 2 Prepared:August 17,2022 ©Copyright, State,Farm Mutual Automobile;Insurance.Company, 2008: CIM Att Dec 3P OR,1 ' FD-6007 1009481 2002 153089 202 03-06-2021 1 002881 ' 0o StateFarme 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 V 2.Customers property in insureds custody limit ' V $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. . • • r , • Policy number:97-CP-D437-B Page 2 of 2 Prepared:August 17,2022 ©Copyright, State Farm Mutual Automobile.In"surance'Compariy,•.'2005 . FD-6007