Loading...
HomeMy WebLinkAboutAmended Insurance Certificate: Rogue Boiler Works LLC JIalerarm 01 R I c rrinrvi nnMIUJ VP1J1JML.I T T U A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,ILLINOIS DECLARATIONS AMENDED OCT 22 2021 o'o® Po Box 85392255 Policy Number 97-CM-L796-1 Richardson, TX 75085-3925 u Addi Insured-Section II Only Policy Period Effective Date Ex•iration Date M-15-2275-FAE6 F E 1 Year JAN 2 2021 JAN 2 2022 001159 3123 The policy period begins and ends at 12:01 am standard THE CITY OF ASHLAND, OREGON time at the premises location. ITS OFFICERS, AGENTS AND EMPLOYEES Named Insured OR 97520-2014 0 N MOUNTAIN AVE ROGUE BOILER WORKS LLC ASHLAND 11111111'1111111 11111111111111111111111111111111111111111111111 a Artisan And Service Contractor Policy .. Automatic Renewal-'If the policy period is shown as 12 months,this policy will be renewedautomatically subjectto the premiums,rules and forms in effect for each succeeding policy period.If this policy isterminated,we will give you-and the Mortgagee/Lienholder written;notice in compliance with the policy provisions or as required by law. . Entity: Limited Liability Company Reason for Declarations: Your policy is amended OCT 22 2021 ADDITIONAL INSURED ADDED. • _ PREMIUM ADJUSTMENT. FORM CMP-4684.1 ADDED • Endorsement Premium None Audit Period:Annual Discounts Applied: Renewal Year Years in Business Claim Record • Prepared NOV 09 2021 ' ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 OR ' Includes copyrighted material of Insurance Services'Office,Inc.,with its permission. 009047 290 Al •'Continued on Reverse Side of Page. . Page 1 of .6 AI • DECLARATIONS(CONTINUED) Artisan And Service ContractorPolicy'for THE CITY OF ASHLAND, OREGON Policy Number - 97-CM-L796-1 • • • SECTION I PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase- Premises Coverage.A- _ Coverage -. Business . Buildings Business Personal . Personal , f ;, , . • :Property Property 001 2105 COREY RD No Coverage- $ 75,000 25% CENTRAL POINT OR 97502-9405 *As of the effective date of this policy, the Limit of Insurance as shown includes•anyincrease in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEX(ES) . v Coy A- Inflation Coverage Index: N/A Coy B-Consumer Price Index: 260.5 SECTION I- DEDUCTIBLES Basic Deductible $1,000 , Special Deductibles: , Equipment Breakdown $1,000 • • Other deductibles may apply- refer to policy. Prepared NOV 09 2021 - ©Copyright,.State Farm Mutual Automobile Insurance.Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. • 009047 .Continued on Next Page Page 2,of 6 5tateFarm L i 0 00 DECLARATIONS(CONTINUED) Artisan And Service Contractor Policy for'THE CITY'OF ASHLAND, OREGON: • ' Policy Number 97-CM-L796-1 ' ' ' • SECTION I- EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE- EACH.DESCRIBED PREMISES • 8 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, please refer to that.policy provision for,an explanation of that coverage. . LIMIT OF COVERAGE. INSURANCE Accounts Receivable _ On•Premises .$1b,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%ofzcovered,loss Equipment Breakdown • Included Fire Department Service Charge - .. $2,500 ' Fire Extinguisher Systems Recharge Expense $5,000 - Forgery Or Alteration - -. . ._ • - . •-• . ... , ...• -41000 - Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are , " • ,. • 10% insured on a replacement cost basis) • Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property(applies only if this policy provides $100,000 Coverage B- Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage,A- Buildings) Ordinance Or Law- Equipment Coverage • • Included • Outdoor Property $5,000 • • Prepared . NOV 09 2021 • ©Copyright,State Farm Mutual Automobile Insurance'Company,2008 • CMP-40.00 OR ' Includes copyrighted material of'InsuranceServices Office;Inc.,with its permission. .. ' 009048 290 • Contiriued on Reverse Side of Page Page' 3 of 6 Al DECLARATIONS.(CONTINUED), • Artisan And Service Contractor Policy,for,THE.CITY OF ASHLAND,OREGON,:.. . Policy Number 97-CM-L796-1 Personal Effects (applies only to thosepremises provided Coverage B- Business . $2,500 • Personal Property) Personal Property, Off Premises $15,000 Pollutant Clean Up And Removal-- ' . - $10;000 Preservation-Of Property . .,s .. sr 30 Days Property'Of Others'(appliesdnly to those premise's provided'Coverage`B = Bus'iriess' '' Personal Property) Signs Y.. $2,500 Valuable Papers And Records On Premises •$1',0,000 Off Premises $5,000 WateE'Damage, Other Liquids, Powder Or Molten Material Damage Included • SECTION II-DEDUCTIBLES Business Liability- Property Damage $500 • Other deductibles may apply- refer to policy. ' SECTION II- LIABILITY LIMIT OF COVERAGE ' INSURANCE Coverage L- Business Liability `' $2,000,000 Coverage,M- Medical Expenses (Any One Person) $10,000 Damage To Premises Rented To You ,„$100,900 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $4;000;000 Prepared NOV 09 2021 ,©Copyright,State farm Mutual Automobile Insurance,company,2008 . CMP-4000 OR Includes'copyrighted material of Insurance Services Office,Inc•,with its permission. 909048 Continued,on Next Page Page 4 of 6 Jrarerarm Li o o'o® DECLARATIONS'(CONTINUED) ' '' Artisan And Service Contractor Policy for THE CITY OF ASHLAND 'OREGON'', -.: Policy Number 97-CM-L796-1 General Aggregate $4,000,000 MI •. I- } ii A • Each paid claim for Liability Coverage reduces the amount of insuranbe.we providetduring the applicable ' ' annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. v,S' 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-4684.1 *Addl Insd Owners Lessee Sched CMP-4600 Artisan and Service Contractor FE-6999.3 Terrorism Insurance Coy Notice CMP-4237.1 Amendatory Endorsement FE-3650 Actual Cash Value Endorsement CMP-4561.1 Policy Endorsement ' CMP-4683.1 Addl Ins Owners Lessee Blkt • CMP-4787 Waiver of Trans Rgt of Recov CMP-4527 Excl Ctrl Substances • CMP-4875 Loss Payable FD-6007 Inland Marine Attach Dec - * New Form Attached • . Prepared . • NOV 09 2021 • ©'Copyri • gh't ;State:Farm Mutual'Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services.office,Inc.,with its permission. 009049 290 • Continued on Reverse Side of Page Page '5 of 6 DECLARATIONS(CONTINUED) .;.,' Artisan And Service Contractor Policy for;THE,CITY;OF ASHLAND,¢OREGON. Policy•Number . 97-CM-L796-1 V ' 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 accordancewith the Company's Articles of Inco•rporation,as amend• ed. 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'.. rn Secretary President • • • Prepared V NOV 09 2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 009049 290 Page 6 of 6 N , Jrarerarm STATE FARM FIRE AND CASUALTY COMPANY O A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,iu.INOIS „INLAND,MARINE ATTACHING DECLARATIONSij O c)„, Box853925_75085-3925 Policy Number 97-CM-L796-1 Named Insured Policy Period Effective.Date Expiration Date M-15-2275-FAE6 F E 1 Year. JAN 2 2021 JAN 2 2022 The policy period begins and ends at 12:01 am standard ROGUE BOILER WORKS LLC time attfie premises location. i • , O 0 ATTACHING INLAND MARINE •:. ' • Automatic Renewal-If the 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/Lienholderwritten notice in compliance with the policy provisions or as required by law. Annual Policy Premium • $ 100.00 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 subsequentto the issuance of this policy. • Forms,Options,and Endorsements FE-8739 Inland Marine Conditions FE-6867 Amend of Inland Marine Condtns FE-8743.1 Inland Marine Computer Prop FE-8756.1 Installation Endorsement FE-8760 Mobile Equipment Form • See Reverse for Schedule Page with Limits Prepared • , , NOV 09 2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 009050 ATTACHING INLAND MARINE SCHEDULE PAGE • • ATTACHING INLAND•MARINE - ENDORSEMENT LIMIT OF'', DEDUCTIBLE . 'ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8743.1 Inland Marine Computer Prop $ 25,000 $ 500 Include d FE-8760. Mobile Equipment Form • $ 20 ,000 $ 500 $' 100 . 0 FE-8756.1 Installation Endorsement $ 5,000 , $ • 500,+.,. ,Inc 1 u d.e d Property in Transit $ 5,000 . ' , • Number of Job-Sites: 1 • • • • • • • • • • OTHER LIMITS AND EXCLUSIONS MAY APPLY-REFER TO YOUR POLICY Prepared NOV 09 2021 ©Copyright,State'Farm Mutunf Automobile Insurance •Company,.2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. • 009050 ' 536.666 a.2 65-31.2611 1011323: