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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald (09) State Farm Insurance LJ POBox 2915 c �p Bloomington,.IL 61702-2915. 0 State armo All 000907 1200 01 •; ,StateFarm fire:and;:Casualty Company CITY OF ASHLAND A stock company with home offices'in Bloomington, Illinois 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 • • II r nlilll I I IIIc I n rlrll II ` -- . IIII IIII IIMII Inlll�i I III II IIII IIII II Amended D clarations . Policy number:97-CP-D437-8 • Effective date:December 12,2022 , 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_for each succeeding policy_period. If this policy_is_terminated, we will give you and the Mol'tgageelLienholder"wr'itten�notice in compliance-uvith the policy provisions oras required bylaw - NAMED INSURED °, �� DONALD ,STRAW ... ENTITY • Sole Proprietorship-Individual REASONS FOR DECLARATIONS . • . :' '' • • .. Your policy is;amended effective,December.12, 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. 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:December 20,2022 . ©Copyright, State Farm Mutual Automobile Insurance'Company, 2008 CMP Dec 3P OR.1 CMP-4000 1009482 2006 153090 206 08-21-2021 StateFarm® 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 FIRST 25% • MEDFORD OR 97501-3616 *As of the effective date of this policy, the Limit of Insurance as shown includes,any increase in thelimit due to Inflation Coverage. SECTION I—INFLATION COVERAGE INDEX(ES) Coy A-Inflation Coverage Index: 203.7 Coy B-Consumer Price Index: 274.3 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 Li• mit of Insurance . �.s r 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:December20,2022 ©;Copyright, State Farm Mutual Automobile Insurance Company, 2006 . CMP-400D Li . �o StateFarme • Coverage , . Limit of Insurance . . , Increased Cost of Cogstructicn and Demolition Costs(applies only when buildings are insured on a 10%, replacement cost basis) Money Orders and Counterfeit Money $1,000 - ; ' S Money and Securities See Schedule -01 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 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 - pack-up of Sewer or Drain - • $15,000 - • iv1oney 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 . 0-Business Personal Property) . . - aigns $5,000 Policy number:97-CP-D437-8 • . Page 3 of 6 Prepared:December20,2022 • ©Copyright, State'Farm Mutual Automobile Insurance Company; 2008 CMP-4000 . • 090 std fe Farm 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 • •- • Off Preniises 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 . - , On Premises Limit - - $10,000 . • Off Premises Limit• -• • •• • .- • .. - $5,000.- .- .... - s', - T; , , '9 -°;' . , .; 1 • - ' ,•:'.,„1 °r' SECTION.I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY The cover.ages;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 - • - Dependent Property-Loss of Income - ' $5,000 - 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'ofdescribed.premises number 001 427 N RIVERSIDE AV • MEDFORD OR 97501-4602' • 003 -. 516'S FIR ST , • - • S • - .. MEDFORD OR 97501-3616 - - - • Policy number:97-CP-D437-8 Page 4 of 6 Prepared:December 20,2022 ©,Copyright, State Farm Mutual Automobile insurance,Company, 2008 - , CMP-4000 u • o: StateFarrme SECTION H-DEDUCTIBLES - • -,w yti Property Damage: $250 '• `+ Other deductibles may apply-refer to policy. • SECTION II-LIABILITY Coverage . ., Limit of Insurance 1-0 Coverage L-Business Liability.Per Occurrence $1,'000,000 Coverage M-Medical Expenses • $10,000 Any One Person • Damage to Premises Rented to You . ', $300,000 -_ Hired Auto Liability Included inCoverage-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 of 6 Prepared:December20,2022 ©Copyright, State Farm Mutual AutomobileInsurance Company, 2006 CMP-4000 , StateFarm 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 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. • f/k e4 - ., rn-' President Secretary • • . ,• . • • Policy number:97-CP-D437-8 Page 6 of 6 Prepared:December 20,2022 ©Copyright, State Farm`Mutual Automobile-Insurance Company, 2008, CMP-4000 . State Farm Insurance U PO Box 2915 Bloomington, IL 61702-2915090 StateFarm® State Farm Fire and Casualty Company CITY'OF ASHLAND A stock company with Norrie offices in Bloomington, Illinois g i.t.: 90 N MO :. - ASHLAND ORUNTAIN 97520-AVE014 O F-6 .. . . . . , ' • • ,- 1 Inland Marine Attaching Declarations .. Policy number: 97-CP-D437-8 Effective date: December 12, 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 Inconle and Extra Expense $25,000 . Included FE-8754 Inland Marine Dealers-Service Form . $500 $374 • Policy number:97-CP-D437-8 , - Page 1 of 2 Prepared:December 20,2022 ©Copyright, State Farm.Mutual Automobile Insurance,Company; 2008 CIM Att Dec 3P OR.1 FD-6007 1009481 2002 153089 202 03-06-2021 • o b StateFar ® 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. • • .- • • Policy number:97-CP-D437.8 • • Page 2 of 2 Prepared:December 20,2022 ©Copyright, State Farm Mutual Autornobile Insurance Company, 2008' FD-6007