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HomeMy WebLinkAboutInsurance Certificate: Emerging Futures Youth Network State Farm Insurance U PO Box 2915 • 9 Bloomington, IL 61702-2915 Q StateFarme AT1 000095 1200 01 ; State Farni,Fire,and.Casualty.Company CITY OF ASHLAND A stock company with home offices ih Bloomington, Illinois 20 E MAIN ST �' 'ASHLAND OR 97520-1814 . 0 C , . . ISI I Ili i IrllillilitIi itItI1i1 1it1I nlilIIIniIIllliI ; . no , 'Renewal . Declarati®ns • . . . . ,.,.t..;.,. . - Policy number:97-CK-S482-9 Effective date:October 16, 2022 Policy period: 12 months Expiration date:October 16, 2023 The policy period begins and ends at 12:01 am standard time at the premises location. .'_;'. '1 , a.;'1,' ,. .i ., i.::. : j, , r' .,.. r r. , ;., w BUSINESSOWNERS 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 polioy period, If this policy_,is terminated, we will,give you and the. -_ . _ - Mortgagee-Lie-Molder written ndtice'in compliance With the pollay',p oVisions or as-required bylaw. - - ' ' - -, NAMED INSURED - . . . . . . . .. .. • • .. _. . _ .. ,--. . EMERGING FUTURES YOUTH NETWORK. - - - • ENTITY .. . :.. . Nonprofit . ' - IMPORTANT MESSAGE(S) . . Notice -Information concerning changes in your policy language is included. Please call your agent if you have any questions: POLICY PREMIUM _ ._ - This is not a bill.If amount isdue,`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 oeclarations. ' Premium: $300.00 Total Premium: $300.00 - - Minimum Premium Discounts applied: . ' . . . . Business Experience Rating . . Renewal Discount ' ' ' • Years in Business Business in Residence Premises ; ,, Policy number:97-CK-S482-9 Page 1 of 5 Prepared:August 8,2022 ©Copyright,,State.Farm.Mutual Automobile Insurance Company, 2008 CMP Dec 3P OR.1 . CMP-4000 1009482 2008 153090 206 08-21-2021 000363 • Q StateFarm® • . • 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 1180,Park St •No Coverage $1,400 ' 25% Ashland OR 97520-3535 *As of the effective date of this policy, the Limit of Insurance has 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: 292.3 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 corresppndiriglimit,shown'below,'''but has`'lnclud'ed"'indicated, refer to that policy provision for an explanation,of that coverage. ' Coverage Limit of Insurance • Accounts Receivable On Premises $10,000 . Off Premises $5• ;000' •. Arson Reward $5,000 • Collapset, 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 ExpensesIncluded 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-CK-5482-9 Page 2 of 5' Prepared:August 8,2022 ©Copyright, State Farm MutUal Automobile Insurance Company,;2008 CMP-4000 • u • 090 State Farms Coverage Limit of Insurance r� �� Money and Securities On Premises• $5,000 Off Premises $2,000 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.. . _ . .. , . , . . ._ $5,000, , .. . Personal Effects(applies only to,thbse premises provided Coverage B-Business Persbnal Property)". 12;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 • • $2,500 ,,.. .., Valuable Papers and Records ,):i$. On Premises $10,000, Off Premises ;,$5,000' • Water Damage, Other Liquids,Powder or Molten Material Damage. '' Included_ SECTIONI—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 number 001 1180 Park St Ashland OR 97520-3535 • Policy number:97-CK-S482-9 i Page 3 of 5 Prepared:August 8,2022 ©Copyright, State Farm Mutual Automobile Insurance Company,:Y2008 S CMP-4000 000364 • 090 State Farm® SECTION II-LIABILITY . Coverage Limit of Insurance Coverage L-Business Liability Per Occurrence $2,000,000 Coverage M Medical Expenses $5,000 Any One Person Damage to Premises Rented to You $300;000 Aggregate Limits • Limit of Insurance General Aggregate $4,000,000 n. Products/Completed Operations Aggregate ' $4,000,000 Each paid claim for Liability Coverage reduces the'amoynt 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-4543 Additional Insured-Designated Person or Organization CMP-4561.1' Policy Endorsement CMP-4705.2 Loss of Income and Extra Expense , CMP-4709 Money and Securities " ". "• • CMP-4787 Waiver of Transfer of Rights of Recovery Against Others To Us • CMP-4788 'Additional Insured-Managers or Lessors of Preinises ' FD-6007 Inland Marine Attaching'Declarations FE-3650 Actual Cash Value Endorsement . FE-6999.3 Policyholder Disclosure Notice pf Terrorism Insurance Coverage ' ' , •'• SCHEDULE OF ADDITIONAL INTEREST(S) `_' `' 1= ,r' '' .\% ; Interest type: ' ' 'Designated Person or Organization. Endorsement number: CMP-4543 Loan number: . N/A " City of Ashland 20EMain St . . . . . _ Ashland OR 97520-1814" •• • Policy number:97-CK-S482-9 '` Page 4 of 5 Prepared:August 8,2022 • ©Copyright, State. Farm'Mutual Automobile'Inurance Company,'2006 CMP-4000 , u o StateFarnr This policy is issued by the State Farm Fire and Casualty Company. v. { 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. no /PfZe_A-444:%cw0 *kust,e,)4/1. President Secretary ' OTHER MESSAGE(S) • NOTICE TO POLICYHOLDER: • For a 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 unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date.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 cost 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 coveragesand limits.withyouur.agent and tonotifyus.of.any..changes..or additions to your structure. . • • • • • Policy number:97-CK-S482-9 • Page 5 of 5 Prepared:August 8,2022 ©Copyright, State Farm Mutual Automobile Insurance Company; 2008 CMP-4000 • . 000365 State Farm Insurance u PO Box 2915 Far me IL 61702-2915 C"O StateFarme State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 4 20 E MAIN ST ASHLAND OR 97520-1814 C • C C C . 0 0)o Inland Marine AttachingDeclarations • Policy number: 97-CK-S482-9 Effective date: October 16, 2022 Policy period: 12 months• Expiration date: October 16;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: 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 theissuance 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 Form '. $25,000 $500 Included Loss of Income and Extra Expense $25,000 . ' Included Other limits and exclusions may apply-refer to your policy. . Policy number:97-CK-S482-9 Page 1 of 1 Prepared:August 8,2022 ©Copyright, State Farm Mutual Automobile Insurance Company, 2005 CIM Att Dec 3P 012.1 F0-6007 1009481 2002 153089 202 03.06.2021 000366