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HomeMy WebLinkAboutAmended Insurance Certificate: Cascade Charter CO. LLC State Farm at CityLine '—' PO Box 853925 Richardson, TX 75085-3925 Q State Farms AT1 000119 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in'Bloomington,•Illinois-,' 20EMAIN ST ASHLAND OR 97520-1814 , . . • S _ . _. _ _ _ O i 11111111111111111111""11111111111"1111111111111111111111111111 COo Amended Declarations • , -. „,,.. . . -., , :,.-,:, ,.- , • . . , Policy number: 97-CP-R296-3 Effective date: April 1, 2021 Policy period: 12 months Expiration date:April 1, 2022 - . . . , , 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 monthsr_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 - - - MortgageelLienhoider written notice in.compliaricewith the'policy provisions or as required bylaw:- - -- " . - -- _ ' - - NAMED INSURED , CASCADE CHARTER COMPANY LLC 2800 BIDDLE RD. ... . .. .. . . .. . . MEDFORD OR 97504-4115 ENTITY ' Limited Liability Company - • . . . REASONS FOR DECLARATIONS . Your policy is amendedeffective April 1, 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 policyas described in this Declarations. . . Total Premium: $766.00 • Discounts applied: Business Experience Rating Renewal Discount Years in Business Policy Number:97-CP-R296-3 Page 1 of 5 Prepared:January 29,2021 ©Copyright,State F.arm•Mutual Automobile Insurance Company,2008 . CMP Dec 3P OR 1009482 2002 153090 202 12-05-2020 CMP-4000 000454 . , • 6YoStateFarme „ . 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 $492,700 $36,990 : ' ?57/. • MEDFORD OR 97504-4115 *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 019EX(ES) Coy A-Inflation Coverage Index: 190.6 Coy.B-Consumer Price Index: 260.4 • . • 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 COVER6 LIMIT OF INSURANCE-EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described preMisesshown in these Declarations,,,..„ unless indicated by'See schedule”. If a coverage does not have a corresponding limit shown below, but has"InCludecr indicated, refer to that policy provision for an explanation of that coverage.• :::; . 2 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 s.1.; • el Damage to Non owned Buildings from Theft Burglary or Robbery Coverage B Limit Debris Removal • 25%of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 n Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration $10,000 Glass Expenses Included Policy Number:97-CP-R296-3 . 5552 of 5 • Prepared:January 29,2021 , 66pytighi,State Farm Mutual Automobile Insurance Company,2008 • CMP.:4000 = u o State Farme • Coverage Limit of Insurance': .- 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 ' , csj CA On Premises $10,000 "At + Off Premises $5,000 Newly Acquired Business Personal Property(appliesonly'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) $5,000 • , ' Personal Property Off Premises $15,000 Pollutant Clean Up and Removal , , $10,000 , Preservation of Property 30'days •, • Property ofOthers(applies only to those premises provided Coverage B'-Business Personal Property)'. $2,500 " 5 . : ' Signs $2,500 Unauthorized Business Card Use $5,000 } Valuable Papers and Records On Premises $50,000 Off Premises ,, , • $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 $10,000 • • Policy Number:97-CP-R296-3 ' - Page 3 o 5 Prepared:January 29,2021 ©Copyright,,State Farm.Mutual Automobile Insurance Company,2008 ' CMP-4000 000455 : : : States ® SECTION II-LOCATION SCHEDULE .• ,.. • Location Location of described premises ,, _ , V 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 BU.SINESSOWNERS 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 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 • ti • •>, , •t..,(:),, 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-6999.3 —Policyholder Disclosure.Notice of Terrorism Insurance Coverage' SCHEDULE OF ADDITIONAL INTEREST(S) , , _ • Interest type: Owners,Lessees;or Contractors(Schedul Endorsement number: CMP-4684.1 . ' . - ,. , .. . .. _ Loan number: N/A CITY OF ASHLAND . , . . . _. .-. , , . . 20 E Main St , Ashland OR 97520-1814 . , .. Policy Number:97-CP-R296-3 , Page 4 of 5 Prepared:January 29,2021 ©Copyright,5tate'Farm Mutual Automobile Insurance Company,2008 • • CMP-4000 . U StateFarme ti 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 Bloomington, Illinois, President Secretary • • • Policy Number:97-CP-R296-3 ' ' ' , ' ' Page 5 of 5 Prepared:January 29,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 000456 State Farm at CityLine' • PO Box 853925 • Richardson, TX 75085-3925 00 State Farm° State-Farm Fire and.Casualty Company CITY OF ASHLAND • A stock company with home offices in Bloomington, Illinois 20 E MAIN.ST I ASHLAND OR 97520-1814 • 0 o , Inland Marine Attaching Declarations . Policy number: 97-CP-R296-3 Effective date: April 1, 2021 Policy period: 12 months Expiration date:April 1, 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, andany 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'Amehdment 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 Other limits and exclusions may apply-refer to your policy. • Policy Number:97-CP-R296-3 Page 1 of 1 Prepared:January 29,2021 ©Copyright;State Farm Mutual Automobile Insurance Company,2008 CIM'Att Dec 3P OR 1009481 2001 153089 201 12-04-2018 FD-6007 000457