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HomeMy WebLinkAboutAmended Insurance Certificate: Better View LLC DBA Farrell's State Farm at CityLine u PO Box 853925 Richardson, TX75085-3925 ° " w State Farm. All 000172 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND FLEET SERVICES , A stock company with home offices inrBloomington,.Illinois. 90 N MOUNTAIN AVE . ":r ASHLAND OR 97520-2014 g . • . o i-,i IIIIIIIIIIIIIiiIIIiIiIIIIiiIIiIill'IIIIIIIIIIIIIIIi'IiiIiIII'iill coO • . Amended Declarations . • . • . . „,,,...:. .. , _:. .„ 1 J',.',' Policy number: 97-AA-B135-1 Effective date: March 12, 2021 Policy period: 12 months Expiration date: June 27, 2021 ' The policy period begins and ends at 12:01 am standard time at the premises location. AUTO SERVICES 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 Mortgagee/Lientiolderwritten notice=in-compliance with-ti e.policy=provisior"s oi:•as-requ'ired'by law. •-' " '.•: '. a .• " ` NAMED INSURED BETTER VIEW LLC DBA FARRELL'S 229 S FRONT ST MEDFORD OR 97501-7263 ENTITY . Limited Liability Company REASONS FOR DECLARATIONS Your policy is amended.effective March 12, 2021 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 is.the 12 months premium(s)for the characteristics of the policy as described in.this Declarations. - _ ' Total Premium: $5,176.00 ' - . ' 5 Discounts applied: . S Business Experience Rating Renewal Discount Protective Devices Years in Business . ' Policy Number:97-AA-8135-1 S Page 1 of 5 Prepared:April 13,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,.2008 CMP Dec 3P OR.1 1009482 2003 153090 203 03.06-2021 5 CMP-4000 000654 = • o StateFarnr 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 001 229 S FRONT ST $589,700 $76,900 ' 25%., MEDFORD OR 97501-7263 *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 I1pFfX(ES) • Coy A-Inflation Coverage Index: 185.4 Coy B-Consumer Price Index: 258.7 SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE .; $500 - SPECIAL DEDUCTIBLES: Employee Dishonesty: $250 Equipment Breakdown: $500 Garagekeepers-Collision: $500 Garagekeepers-Comprehensive: $250 _ Money and Securities: $250 Other deductibles may apply'-refer to policy. SECTION I—EXTENSIONS OF CQVERAi4 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 $10,000 . • Off Premises $5;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,, Debris Removal 25%of covered loss . Employee Tools(applies only to those premises provided Coverage B-Business Personal Property) . Per Employee $500 Per Occurrence $2,500 Equipment Breakdown Included Policy Number:97-AA-B135.1 ' . , Page 2 of 5 Prepared:April 13,2021 ©Copyright,State Farm Mutual AutomobileInsurance Company,2008' ,. CMP-4000 ' LI StateFarm° Coverage Limit of Insurance . ~' - - , -• " • 7 7zr1 Fire Department Service Charge $5,000' ' • - - Fire Extinguisher Systems Recharge Expense - $5,000 . Forgery or Alteration $10,000 . . Garagekeepers Insurance-Direct Coverage $25,000 7)o Glass Expenses . . Included ' 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 -- • • - . - - - • - - , ._ On Premises • -- $10,000 • Off Premises - - • $5,000 • - • 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 0Included , 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 - - • . . .. ' - ' Pollutant Clean Up and Removal $20,000 • • Preservation of Property - 30 days Property of Others(applies only to those premises provided Coverage-.B'-Business Personal Property). . $2,500 Signs . . . $5,000 Valuable Papers and Records - • On Premises ..... • . . .. .. • .: .. . .. : .• $10:obo • . Off Premises . .Th- -• ,- , ,•• $5,000, ' ' '. • 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 . • Employee Dishonesty . . ' $10,000 • • Loss of Income and Extra Expense - 12 Months Actual Loss .Sustained - • Policy Number:97-AA-B135-1 Page 3,of 5 Prepared:April 13,2021 ©Copyright;State Farm Mutual Automobile Insurance Company;2008• CMP-4000 000655 • • 0°0 State Farm® SECTION II-LOCATION SCHEDULE . ' Location Location of described premises: . . • ' number• - • • • 001 229 S FRONT ST .. - MEDFORD OR 97501-7263 . ' . ' SECTION II-DEDUCTIBLES. • Property Damage: $250 . . Other deductibles may apply-refer to policy. , . .. . . SECTION II-LIABILITY • . . - • Coverage ' .. . • ' . - • Limit of Insurance ' , • • Coverage L-Business.Liability Per Occurrence -- . . $1,000,000 • . Coverage M-Medical Expenses - - $5,000 Any One Person Damage to Premises Rented to You • $300,000 Garage Liability , Included in Coverage L Operation of Customers'Auto on Particular Premises , . .,.F, Included . • Aggregate Limits Limit of Insurance - Products/Completed Operations Aggregate $2,000,000 - . General 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 ANL)ENDORSEMENTS • CMP-4100 Businessowners Coverage Form CMP-4237.1 Amendatory Endorsement(Oregon) _ -. . . .- . CMP-4412 Operation of Customers'Auto on Particular Premises ' ' .. .... • CMP-4527 Marijuana Exclusion --. • - • CMP-4543 Additional Insured-.Designated Person or Organization. . ' ' • 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-4706 Back-up of Sewer or.Drain " CMP-4709 ., , Money.and Securities: , . CMP-4710 Employee Dishonesty . CMP-4742.1 Garage Liability CMP-4744 Garagekeeper's Insurance-Direct Coverage • . _ CMP-4787 Waiver of Transfer of Rights of Recovery Against Others To Us CMP-4788 , Additional Insured-Managers or Lessors of Premises CMP-4827.1 Employee Tool Coverage . FD-6007 • Inland Marine Attaching Declarations - • FE-3650 Actual Cash Value Endorsement •Policy Number:97-AA-B135-1 ' ' .Page 4 of 5 • ' Prepared:April 13,2021 , ©'Copyright,State Farm Mutual Automobile Insurance Company,2008 • , CMP-4000 u °a StateFarme FE-6999.2 Policyholder Disclosure Notice of Terrorism Insurance Coverage 4.• SCHEDULE OF ADDITIONAL INTEREST(S) Interest type: Owners,Lessees,or Contractors(Schedul Endorsement number: CMP-4684.1 Loan number: N/A o CITY OF.ASHLAND FLEET SERVICES/FACILITIES MAINTENANCE �. 90 N Mountain Ave N o Ashland OR 97520-2014 • FULL NAMED INSURED Named Insured: BETTER VIEW LLC DBA FARRELL'S GLASS SERVICE _ This policy is issued by the State Farm Fire and Casualty Company, PARTICIPATING POLICY Youare entitled to participate in a distribution of the earnings of the company as determinedby 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, /11te-4, 4Pc49-0 President Secretary • Policy Number:97-AA-8135-1 • Page 5 of 5 Prepared:April 13,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 000656 State Farm at CityLine • PO Box 853925 P ® Richardson,.TX 75085-3925 CPO Stat`+e Farm • • State Farm Fire and Casualty•Company . CITY OF ASHLAND FLEET SERVICES • A stock company with home offices in Bloomington, Illinois 90 N MOUNTAIN AVE • • • ASHLAND.OR. 97520-2014 • • •O • En • • Inland Marine Attaching Declarations Policy number: 97-AA-B135-1 • Effective date: March 12, 2021 Policy period: 12smonths • Expiration date: June 27, 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 required by law. Annual policy premium: Included The above premium amount is included in the Policy Premium shown on the Declarations. FULL NAMED INSURED Named Insured: BETTER VIEW LLC DBA FARRELL'S GLASS SERVICE 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 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 Policy Number:97-AA-B135-1 • " . Page 1 of 2 Prepared:April 13,2021 ©Copyright,.State Farm•Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR.1 1009481 2002 153089 202 03.06-2021 FD-6007 000657 • 00 StateFarm® Other limits.and exclusions may apply-refer to your policy. • •- • • • • • • • Policy Number:97-AA-B135-1 " Page 2 of 2 Prepared:April 13,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007