Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Insurance Certificate: Straw, Donald
State Farm Insurance PO Bonto 15 q'O State!arm. Bloomington; IL'6-1702-2915 1 AT1 000394 1200 01 ,}State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 90 N MOUNTAIN AVE Ela ASHLAND OR 97520-2014 _ , . ' o . 1-� 1111111111111111111111111111"1111111111111111111111111111111111 =- - . . .'.. Amended Declarations : 1 , , , , ,.: , ..:. : :, ......,..,r , ::::,, .,, ..,., ! .. ,,, ,,, .,. . , Policy number:97-CP-D437-8 Effective date:April,21, 2023 _ Policy period: 12 months • Expiration date:'February 18, 2024 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 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 �. DONALD STRAW . , , ENTITY : . . Sole Proprietorship-Individual REASONS FOR DECLARATIONS ' . Your policy is amended effective April'21, 2023 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 amountis 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: $7.00 . - . ' _ Discounts applied: Business Experience Rating . ' Renewal Discount - ' Protective DevicesYears in Business Policy number,97-CP-D437-8 • Page,1 of 6 Prepared:May 11,2023 ©Copyright,,State:Farm Mutual Automobile Insurance Company, 2008-. CMP Dec 3P OR.1 CMP-4000 1009482 2006 153090 20608-21-2021 • '63 State Farm. 'SECTION I-PROPERTY SCHEDULE BLANKET Limit of Insurance* Coverage A-Buildings: $1,093,200 Coverage B-Business Personal Property: $491,400 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:: • " 216.3 • • Coy B-Consumer Price Index: 298 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 Declaration, 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 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 11,2023 ©.Copyright, State Farrri Mutual'Automobile Insurance Company, 2008 CMP-4000 U Statefarmo Coverage Limit of Insurance 1 • Increased Cost of Construction and Demolition Costs(applies only when-buildings are insured on.a .- 10%--- • ..- cost basis) _ 1 , - Money Orders and Counterfeit Money : , $1,000 Money and Securities See Schedule . coo 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 - .. ,:i.: 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 l. - 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 11,2023 • . C Copyright, State.-Farm.Mutual Automobile, Insurance.Company, 2p08 , •• . CMP-4000 090StateFarm® • 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•• - V ' - - - - 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 - .- • Valuable Papers and Records - • V • On Premises Limit . . $10',000, • - .- ' • -• • Off Premises Limit - - - • - -- - —$5,000 SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY V 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 • -V • -- V° ~- V" Limit of Insurance • , ; V - - Dependent Property-Loss of Income - • -- V- - V - $5;000 • .V . - ._ Employee Dishonesty - ••$10,000 VLoss 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' . 003 516 S FIRST . V V V - MEDFORD OR 97501-3616 - .- , • .• ' • Policy number:97-CP-D437-8 Page 4 of 6 . Prepared:May 11,2023 ©Copyriglit, State'Farm Mutual Automobile:Insurance Company,2008 •, CMP-4000 - u • a StateFarrne SECTION II-DEDUCTIBLES . . • Property Damage: " $250 Fi y .- Other deductibles may apply=refer to policy. . SECTION II-LIABILITY Coverage Limit of Insurance gCoverage 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. 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 4246.1._._...: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: NIA '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 11,2023 ©.,Copyright, State Farm Mutual Automobile. Insurance Company, 20.08, , • . CMP-4000 00 StateFarme Named'Insured: DONALD E STRAW DBA FASHION FLOORS This policyis 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 its President and Secretary at Bloomington, Illinois: ' • ' I I President Secretary • Policy number:97-CP-D437-B • Page 6 of 6 Prepared:May 11,2023 ©Copyright,State Farm Mutual Automobile Insurance'Compafiy,'20013' CMP-4000 . u State Farm Insurance ' • • PO Box 2oOCD State Farms f3loomington, IL 61702-2915 State Farm Fire and Casualty Company CITY OF ASHLAND • A stock company with home offices in Bloomington, Illinois 90 N MOUNTAIN AVE - - _ _. • . . •L: ASHLAND OR 97520-2014 . • • ' o . _ . . • O (17)s . • . .. : . Inland Marine Attaching. Declarations . . . . . . • , Policy number: 97-CP-D437-8 Effective date:April 21, 2023 Policy period: 12 months ': • Expiration date: February 18, 2024 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-D437-8Page 1 of 2 Prepared:May 11,2023 . . ©Copyright, State Farm,•Mutual Automobile Insurance Company, 2008 • CIM AttDec3P OR.1 ' FD-6007 1009481 2002 153089 202 03-05-2021 • -090 StateFarnr Endorsement . , Coverage , ' Limit of insurance Deductible amount Annual premium number • Description of Property:FLOOR COVERINGS&TOOLS . .. : ' 1.Insuredsproperty 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 " • . ... .. .. . ... .- - - -- . - -- ... _. .. . . . .. .............. ._ .r.... ______ 1. ..v -. . _...., 4 , �, a .,.. '•e.:' .. ., iii.. . , Policy number:97-CP-D437-8• Page 2 of 2 Prepared:May 11,2023 ©Copyright, State`Farm Mutual Automobile'Insurance Company,;2008 • FD-6007