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HomeMy WebLinkAboutInsurance Certificate: Cascade Charter Co. LLC State Farm at CityLine L-' PO Box 853925 Richardson, TX 75085-3925 090 0 StateFarnr AT1 000253 1200 01 State Farm Fire and Casualty Company giiCITY OF ASHLAND A stock company with horne offices'in'•Bloomingtonr Illinois '20 E MAIN ST ASHLAND OR. 97520-1814 O p ,$ iiiiiIIIiiiiiilrliilliillvlllilothlllll'IIlIuIiiiiiiiiiiiiriii Ma 1 Amended Declarations. . .. .. ,,,i,,,, ";:;32....•: i','' 1.:..,,J...'-t Policy number: 97-CP-R296-3 Effective date: January 28, 2021 Policy period: 12 months Expiration date:April 1, 2021 The policy period begins and ends at 12:01 am standard time at the premises location. _ OFFICE 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 MortgageeILienholder whtten notice Incompliance with the policy provisions or as required bylaw - -------72- NAMED INSURED . CASCADE CHARTER COMPANY LLC 2800 BIDDLE RD _. . . . . MEDFORD OR 97504-4115 ' V ENTITY ' Limited Liability Company '; REASONS FOR DECLARATIONS Your policy is amended effective January 28, 2021 due to some're'cent policy changes,you requested, Enclosed is a copy of'Your-'new endorsements, if any. ,. POLICY PREMIUM This is not a bill.lf 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 policy as described in this Declarations. • .. - Total Premium: $881.00 •.- - Discounts applied: V , _ .. Business Experience Rating Years in Business ' - ' Policy Number:97-CP-8296-3 • Page 1 of 5 Prepared:January 28,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 , • CMP Dec 3P OR 1009462 2002 153090 202 12.05-2020 CMP-4000 000976 , . ' • StateFarn , 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 2800 BIDDLE RD $475,800 $36,400 25%. MEDFORD OR 975044115 *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: 184.1 Coy B-'Consumer Price Index: 257.3 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 Limit of Insurance Accounts Receivable On Premises, $50,000 Off Premises $15,000 Arson Reward $5,000 - Back-up of Sewer or Drain $15,000 Collapse Included" Damage to Non-owned Buildings from Theft,Burglary or Robbery Coverage B Limit ''`i Debris'Removal 25%of covered loss Equipment Breakdown Included . Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration $10,000 Glass Expenses Included Policy Number:97-CP-R296-3 Page 2 of 5 Prepared:January 28,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 . CMP-4000 . u State Farm' CoverageLimit of Insurance j• nh•"- • " • - . Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a 10%c ' replacement cost basis) Money Orders and Counterfeit Money, $1,000 Money and Securities - • ..- • 0 - - V - co o On Premises $10,000 ' • t Off Premises ' • $5,000 Newly Acquired Business Personal Property(applie• s 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) ". $2511,000 • Ordinance or Law-Equipment Coverage - " Included V Outdoor Property - • , ' $5,000 • ' Personal Effects(applies only to those premises provided Coverage B-Business Personal Property) $5,000 •' • ' . . ' -' • Personal Property Off Premises $15,000 V Pollutant Clean Up and Removal . • . , . • .• , • . $10,000, - , ' . Preservation of Property 30 days " Property of Others(app'lies Only to those premises provided Coverage B Business Personal'Property) $2,500 . Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers and Records On Premises $50,000 ' , Off Premises • , •s-". • • $15,000 Water Damage, Other Liquids,Powder or Molten Material Damage. • • Included • • ' ''„ •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. 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 V $10,000• • . Policy Number:97-CP-R296-3 . . Page 3 of 5 Prepared:January 28,2021 ©,Copyright,State Farm Mutual Automobile Insurance Company,2008 V . • • CMP-4000 , 000977 . ooStajeFarme • SECTION II-LOCATION SCHEDULE. Location Location of described premises , number ' 001 2800 BIDDLE RD , MEDFORD OR 97504-4115 '' 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 . $4,000,000, , . General Aggregate $4,000,000 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 wellas 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-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-4787 Waiver of Transfer of Rights'of Recovery Against Others To Us CMP-4819.1 Unauthorized Business Card Use • FD-6007 Inland Marine Attaching Declarations FE-3650 Actual Cash Value Endorsement FE=6999.2 .. Policyholder Disclosure Notice of Terrorism Insurance Coverage . ' "" " " SCHEDULE•OF ADDITIONAL INTEREST(S) - - Interest type:. Owners,Lessees,or Contractors(Schedul Endorsement number: 'CMP-4684.1 ' V ' Loan number: N/A , .CITY OF ASHLAND _ ._ .. .-. . • _ 20EMain St Ashland OR 97520-1814 • Policy Number:97-CP-R296-3 • Page 4 of Prepared:.January 28,2021 C Copyright,State Farm Mutual Automobile Insurance Company,2008 ' CMP-4000 . u o o StateFarm® 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 coo Bloomington, Illinois. President Secretary Policy Number.97-CP-R296-3 Page 5 of 5 Prepared:January 28,2021 ©Copyright,State.Farm Mutual Automobile Insurance.Company,2008 CMP-4000 000978 LI State Farm at CityLine PO Box 853925 Richardson, TX 75085-3925 CFO StateFarnr State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 20EMAIN ST VN ASHLAND OR 97520-1814 0 o Inland Marine. Attaching Declarations Policy number: 97-CP-R296-3 Effective date: January 28, 2021 Policy period: 12 months Expiration date:April 1, 2021 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 requiredby law. Annual policy premium: Included The above premium amount is included in the Policy Premiumshown 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-Pro ert 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-CP-R296-3 Page 1 of 1 Prepared:January 28,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR 1009481 2001 153089 201 12-04-2018 FD-6007 000979