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HomeMy WebLinkAboutAmended Insurance Certificate : Wild Rivers Surveying LLC State Farm at CityLine U PO Box 853925 /a : Richardson,.TX 750.8 -3925 CFO CtateFa/m AT2 000518 1200.01 State Farm Fire and Casualty Company aTHE CITY OF ASHLAND A stock company with home offices'iri'Bloomington;:Illinois 20EMAIN ST ASHLAND OR 97520-1814 . _ . _ • _ Eli 111"11111111111111111-lIIII1uIiiI1IIIIil1iIu1ullll1lliiIIIIlr' . cno Amended Declarations - • ' .. . • .. , „ . , . ,. • . - . . : 2.,::!..!::,:!MCE•ik.,i :YiUri:',:r1%.*:. - Policy number: 97-CN-X256-3 Effective date: January 24, 2021 Policy period: 12 months Expiration date: January 24, 2022'' •' '- The policy period begins and ends at 12:01 am standard time at the premises location, L. BUSINESSOWNERS POLICY Automatic renewal -If the State Farm°policy, period is;shown'.as.12 months,,,thistpol.iey,will-,be'renewed•automatically,subject,to the: __ :._-_premiums,-.rules and;forms in:effect:forr each-succeeding,policy period.-If_this;policy is terminated;-:we,will give.you-and-the _. ..-___: _ MortgageelLienholder written notice in compliance with the policy provisions or as required by law. ' ' NAMED INSURED . • • . WILD RIVERS SURVEYING, LLC . 3339 GREEN ACRES DR - •.. - - • CENTRAL POINT OR 97502-1413 ENTITY . . . •Limited Liability Company , . REASONS'FOR DECLARATIONS ., . . ' Your'policy is-amended effective;January.24,'2021 due to some"recent policy changes. you you requested:Enclosed'is a copy of youtriew 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 is the 12,months_ premium(s)for the characteristics of the poiicy as described in this Declarations. . '. Total Premium:.$385.00 .. Discounts applied: " Business Experience Rating Renewal Discount • Years in Business - Business in Residence Premises Policy Number:97-CN-X256-3 • Page 1 of 5 Prepared:December 21,2020 ©Copyright,State Farm Mutual Automobile.Insurance Company;-2008 CMP Dec 3P OR 1009482 2002 153090 202 12-05-2020 CMP-4000 nnoanv - . - o•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 Building Personal Property 001 3339 GREEN ACRES DR No Coverage $27,100 . ; , ; 25% CENTRAL POINT OR 97502-1413 *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 - - Cov B-Consumer Price Index: 259.9 - - SECTION I—DEDUCTIBLES . BASIC DEDUCTIBLE $500. . , SPECIAL DEDUCTIBLES: . . , . • Employee Dishonesty: $250 • Equipment Breakdown: $500 Money and Securities:' $250 - Other deductibles may apply-refer to policy., - - ..L 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. 0 ;• ,':,•.• i; r',: Coverage Limit of 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 Robbery Coverage B Limit `• Debris Removal • 25%of covered loss Equipment Breakdown - ' • - ' ' '`'t ' ' ' 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-CN-X256-3 •• Page 2 of 5 Prepared:December 21,2020 ©Copyright,State Farm Mutual Automobile Insurance Company;2008 CMP-4000 . . . u ., 0Q StateFarm® Coverage _ Limit of Insurance ",i!..,'•:),',., , -'''''�" i 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 - - - § • Money and-Securities • • • -- _ . . n o • 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 those premises provided Coverage B-Business Personal Property) . ,_$2,500; ., Personal Property Off Premises • $15,000 . '1': . .TT., ,::1:,:,..1..?;,, •,;a;. Pollutant Clean Up and Removal $10,000_ . • Preservation of Property ' '30 days , ' ., ' Property of Others(applies only to those premises provided Coverage Bl-Business•Personal•Property)' $2,500 , Signs $2,500, . • . .. Valuable Papers and Records' . On Premises $10,000 • Off Premises _ , $5,000 , . Water Damage, Other Liquids,Powder or Molten Material Damage • V Included V 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. _- _ ,. . - .. : . . • CoverageLimit of Insurance ' Employee Dishonesty $5,000 Loss of Income and Extra Expense 12 Months Actual Loss Sustained 'SECTION II-LOCATION SCHEDULE • Location Location of described premises • number . • '001 3339 GREEN ACRES DR • CENTRAL POINT OR 97502-1413 ' Policy Number:97-CN-X256-3 . ' • .'Page 3 of 5 Prepared:December 21,2020 ©Copyright,State Farm Mutual Automobile Insurance Company;2008 .. CMP-4000 002303 . . .«Ρ 0o StateFarm® SECTION II-LIABILITY • . ... , , _ , Coverage , , Limit of Insurance • Coverage L--Business Liability Per Occurrence $2,000,000 - Coverage M-Medical Expenses - - - - • -•- $10,000.Any One'Person - • • Damage to Premises Rented to You -• - • -$300,000 • Aggregate Limits Limit of Insurance . Products/Completed Operations Aggregate - , - $5,000,000 • - • . - . , . . General Aggregate - $5;000,000 •• . - . Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual.period.'Please refer to Section'll—. 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 Exclusiion. CMP-4561.1 Policy.Endorsement - . . - . CMP-4683.1 Additional Insured-Owners,Lessees or Contractors(Blanket) . . . .• • CMP-4684.1 Additional Insured-Owners,Lessees or Contractors(Scheduled). - .. CMP-4705.2 Loss of Income and Extra Expense CMP-4709 .• Money and Securities . . - - . • CMP-4710 Employee Dishonesty . _ CMP-4787 Waiver of Transfer of Rights of Recovery Against Others To Us - .. • • CMP-4788 Additional Insured-Managers or Lessors of Premises 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: CMP4684.1 ' . , . • Loan number: N/A . • The City of Ashland 20 E Main St Ashland OR 97520-1814 - . - . . .. • Policy Number:97-CN-X256-3 • Page 4 of 5 Prepared:December 21,2020 ©Copyright,State Farm,Mutual Automobile Insurance Company,'2008 CMP-4000 oQ State Farina This policy is issued by the State Farm-Fire and Casualty Company. • l PARTICIPATING POLICY You are entitled to participate in a distribution of the earnings of the companyas 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 ,10 Bloomington, Illinois. /frit•eLd4:, President S Secretary Policy Number,97-CN-X256-3 Page 5 of 5 Prepared:December 21,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 nand State Farm at.CityLine LJ PO Box 853925 Farms' Richardson, TX 75085.3925 State090090 • State.Farm Fire and Casualty Company THE CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois Da20 E MAIN ST ASHLAND OR 97520-1814 • •S O O �o Inland Marine AttachingDeclarations .• Policy number: 97-CN-X256-3 Effective date: January 24, 2021 Policy period: 12 months • Expiration-date: January 24, 2022 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 the issuance of this policy. FORMS,OPTIONS AND ENDORSEMENTS FE-6867 Inland Marine Amendment of Inland Marine Conditions • FE-8739 Inland Marine Conditions FE-8743.1 Inland Marine Computer Property Form See below for schedule pagewith limits ATTACHING INLAND MARINES 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-CN-X256-3. Page 1 of 1 Prepared:December 21,2020 ©Copyright,State Farm Mutual Automobile Insurance Company;2008 • CIM AC Dec 3P OR 1009481 2001 153089 201 12-04-2018 FD-6007 nroanc CMP-4684.1 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. L ADDITIONAL INSURED—OWNERS, LESSEES,OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 97-CN-X256-3 Named Insured: WILD RIVERS SURVEYING, LLC 20 E Main St Ashland OR 97520-1814 Name And Address Of Additional Insured Person Or Organization:: The City of Ashland 20 E Main 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 V a. Ongoing Operations With respect to liability for "bodily injury", "property damage", or 'personal and advertising injury" caused by your ongoing operations for that additional insured and only to the extent that such "bodily injury", "property damage" or "personal and advertising injury" is caused by your negligence or the negligence of those performing operations on your behalf; or b. Products-Completed Operations ; To the extent that the liability for "bodily injury" or "property damage" is caused by "your work" performed for that additional insured and included in the"products-completedoperations hazard", 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-4684.1 155042 03.20-2019 ©, Copyright, State Farm Mutual Automobile Insurance Company,2018 • , Includes copyrighted material of Insurance Services Office, Inc.,with its permission.