Loading...
HomeMy WebLinkAboutInsurance Certificate: Wild Rivers Surveying LLC State Farm at CityLine \ LI PO Box 853925 • ;Richardson, TX 75085-3925 09C5 StateFatme AT2 000246 1200 01 State Farm Fire and Casualty Company THE ASHLAND CITY COUNCIL A.stock company with home;offices'in:Bloorningtori Illinois 20 E MAIN ST ASHLAND OR 97520-1814 , • O "11111111111"111111111111111111111"11'111111111111"1111" �s Renewal Declarations • 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. BUSINESSOWNERS POLICY Automatic renewal -If the State Farm°,policy.period,is'shown as 12 months; this,policy-.will be renewed;autornatically'subjept,to;the - premiums, rules and forms in-effect-for-each!succeeding policy=period, If this.policy,is_terminated,;we will_give,You-and the. MortgageelLienholder written notice incompliance with 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 IMPORTANT MESSAGES) 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./fan amount is due;thin a.sejoarate statement will be sentprior 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 Declarations. • Total Premium: $377.00 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:November 16,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 .. CMP Dec3P OR 1009482 2002 153090 202 06-05-2020 CMP-4000 'ooStateFarms. SECTION I;-PROPERTY,SCHEDULE ' .'.;r {. 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 1, 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) . Cov A-Inflation Coverage Index: N/A Coy 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. _' iw,'• . 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"Incl'uded" 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 ; ?i_` fir. Collapse Includedr Damage to Non-owned.Buildings from Theft,Burglary or Robbery . Coverage B Limit '4• 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-CN-X256-3 :Page 2 of 5 Prepared:November 16,2020 . ©Copyright,State Farm Mutual Automobile Insurance Company;2008 CMP-4000 u • 090.StdteFarmo Coverage Limit of Insurance ° 'rt` : Rt., Increased Cost of Construction and Demolition Costs(appliesonly when buildings are insured on a 10% replacement cost basis) • Money Orders and Counterfeit Money - $1,000 • § Money and Securities - • - o 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 •;::: .r.!;,r. -ti•,'°,: Pollutant Clean Up and Removal • ' $10,000 .t Preservation of Property 30 days . Property of Others(applies only to those premises provided Coverage B-B'usiness'Personal Property) . $2,500 ' ` • ' Signs •. $2,500 Valuable Papers and Records ;.k , • ' On Premises $10,000 . t Off Premises $5,000,. ,. • , Water Damage, Other Liquids,Powder or Molten Material Damage Included SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY :: >>'.1.':i;f: ;' ;rj ;•:: 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 , • •• Employee Dishonesty $5,000 , . ., Loss of Income and Extra Expense 12 Months Actual Loss Sustained SECTION II-LOCATION SCHIrpULE 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:November 16,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 nnimi . . . . , . 09Q State Farm® . . ,.. _ . „ . ... . . . . SECTION II-LIABILITY • ., .. . ... .. . .. . . . .. . . ., .... .._. .._ , , Coverage . ' ' ' • ' - • Limit of Insurance' t • . . . • . . , • Coverage L-Business Liability Per Occurrence V V V V - V • • $2,000,000 •, . .'. . , . Coverage M-Medical Expenses • V • V V - - V $10,000 Any One Person , . Damage to Premises Rented to You . .V _ . -- • - - $300,000- - • . v• , • '... . . Aggregate Limits Limit of Insurance . Products/Completed Operations Aggregate ' • ' , -• • , , • .. .V V, ' , , $5;000;000. . . • -General Aggregate •• — _ . ' - • $5,000,000. ' ' . , . . „ • . . . Each paid claim for Liabil0 Coverage reduces.the amount bf insurance we provide'during the applicable annual period. Please refer to Section II- Liability in the Coverage Form and any attached endorsements. VVVVVV • , V , . . 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 V Amendatory Endorsement(Oregon) . . . . . . . . CMP-4527 Marijuana Exclusion, . V;I, ' . -CMP-4561.1 Policy Endorsement:- • • . . V , . CMP-4683.1 Additional Insured-Owners,Lessees or Contractors(Blanket)V ' 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 V V Waiver of Transfer of Rights of Recovery Against Others To Us - - - . . CMP-4788 V Additional Insured-Managers or Lessors of Premises V ' . • --FD-6007 ' Inland Marine Attaching Declarations V. -V V V . _ „ . . FE-3650 V Actual'Cash Value Endorsement . ' ' ' . . * FE-6999.3 Policyholder Disclosure Notice of Terrorism Insurance Coverage *New FORT?Attached ' ' . ... . . . . . ., . _ _ • ., ._ . . V _ VV .V . . V... SCHEDULE OF ADDITIONAL INTEREST(S) '..'•r '1 -1 . ,!.. ...i, '!.....; •..::: ,'• :.::?;.•‘.; _'• 'Ir.-.)• '!:../1 '• . , Iriterest type: ' V Owners,Lessees;or Contractors(Schedul . „ ,. . , ., • ' Endorsement number: CMP-4684.1 . . Loan number: , N/A . • , . The Ashland City Council , ' ' • "•• . . .• . . 20 E IVIain St • — • — VVVVVVVVVVVVVV VVVVVVVV - Ashland OR 97520-1814 . ' . . , , . . . , . - . ._ . . . _ _ „. . . . . _. .. . . .. . • . - - _ ' •-, ;!,,, ' '.,','.... i '''' .'i• V '_ • - • • , - • • , ., Policy NuMber:97-CN-X256-3 V V • . Page 4 of 5 Prepared:November 16,2020 " • ©Copyright,State Farm Mutual Automobile Insurance Company,200E1 CMP-4000 , • v v u • 42)• SfdfeFarm • This policy is issued by the State Farm Fire and Casualty Company. • 4 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. ow04.840 LL m President Secretary 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 separateendorsement, binder, or amended declarations. Any'coverage forms attached to this notice are also effective on the Renewal Dateof 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 coverages and limits with your agent and to notify us of any changes or additions to your structure. • Policy Number:97-CN-X256-3 Page 5 of 5 Prepared:November 16,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 111 State Farm at CityLine PO Box 853925 • Richardson, TX 75085-3925 090 State Farnr State Farm Fire and Casualty.Company THE ASHLAND CITY COUNCIL . A stock company with home offices in Bloomington, Illinois fa20EMAIN ST . • ASHLAND OR 97520-1814 . S s Inland Marine Attaching:., Declarations 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 MARINA Automatic renewal -If the State Farm®policy periodis 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 policyconsists 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 page with limits ATTACHING INLAND MARINE SCHEDULE PAGE Endorsement Coverage . Limit of insurance Deductible amount. Annual premium number • S 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:November 16,2020 ©Copyright,State Farm Mutual Automobile insurance Company,2008 CIM Att Dec 3P OR 1009481 2001 153089 201 12-04-2018 FD-6007 nnima 0 CMP-4684.1 Page 1 of 1 THIS,ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 20EMain St Ashland OR 97520-1814 Name And Address Of Additional Insured Person Or Organization: The Ashland City Council 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: 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 causedby 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-completed,operations 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.