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HomeMy WebLinkAboutAmended Insurance Certificate: Straw,Donald E. DBA Fashion FL State Farm at CityLine Li PO Box 853925 Richardson, TX 750853925 006 State a mo AT1 000424 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND A stock'company with•home offices.in Bloomington,nilllinois .;+ 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 )$ IIIIiIIIuIIIIIutuliIIIIIIInriIIIrinIIIIIu111111IiiIIiIIIIIIIilI . Amended Deca rata nis r 4 Policy number: 97.7CP D437-8`, s f: : i :,;; ► ,,, ,;.;:1... y :' Effective date,April 2021: ' ''' Policy period: 12 months Expiration date:•February 18, 2022 ' The policy period begins and ends at 12.•01 am standard time at the premises location, HOME PRODUCT SALES P01AY Automatic renewal -If the State Farm®policy periodis shown as 12 months, this policy will be renewed automatically subject to the • premiums; rules and formOm:effect.foreach succeeding po'icy, period..,.If this pojicy is terminated,;we_will.give,you the • Moftgagee/Lieriholder wriffen'nofice'in complianoe wntli'the°policy provisions oc es required by Jaw: ' ,and 'V�` NAMED INSURED STRAW, DONALD E DBA FASHION FL' : , �,.,.' . • `t ; , 427 N RIVERSIDE AVE MEDFORD OR 97501-4602 . • ENTITY 2. Sole,Proprietorship=individual REASONS FOR DECL'ARATIV $ • o-t Your'policyis-amended`effective April 19 ;2021 due to:some:recent policy changes you requested:,Enclosed is:a-copy,of your new endorsements,.if any, POLICYPREMIUM- ' 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: $4,161,00 Discounts applied: Business,Experience Rating - Renewal Discount. ;Protective Devices • - Years in.Business Policy Number:97-CP-D437-8 Page 1 of 6 Prepared:April 20,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP Dec 3P OR.1 1009482 2003 153090 203 03.06.2021 CMP-4000 001665 0o StateFarnr SECTION I-PROPERTY SCHEDULE—BLANKET • • Limit of insurance* ] Coverage A-Buildings: $961,200 Coverage B-Business Personal Property: $432,800 ' • Location Location of described premises Seasonal increase- number Business Personal Property'•:- ' . . , 001 427 N RIVERSIDE AV 25% MEDFORD OR 97501-4602 003 516 S FIRST . 25% MEDFORD OR 97501-3616 *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: 190.2 Coy B-Consumer Price Index: 260.4 , SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE $1,000 . SPECIAL DEDUCTIBLES: . Employee Dishonesty: $250. . Equipment Breakdown: $1.,000 , Money arid 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 • .See Schedule -•- , • Arson Reward .: .. . . : ....• . ,..$5,000... Back-up of Sewer or Drain See Schedule Collapse Included 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 $2,500 Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration $10,000 Policy Number:97-CP-D437-8 . •Page 2 of 6 Prepared:April 20,2021 '©Copyright,State Farm Mutual Automobile Insurance Company,2008 ' CMP-4000 LJ Q StateFa1'h1® Coverage Limit of Insurance . ' VAGlass Expenses Included " , Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a- 10% - replacement cost basis) . ca Money Orders and Counterfeit Money $1,000 V,Es; Money and Securities See Schedule' Newly Acquired Business Personal Property(applies'only if this policy provides Coverage B-Business $100,000 '` V ' 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 .` ' See Schedule. ;t' Personal Effects(applies only to those premises provided Coverage B-Business Personal Property), $2,500 - : _ Personal Property Off Premises $25,000 ' Pollutant Clean Up and Removal ' ' $10,000 ' , Preservation of Property30 days , Property of Others(applies only to those premises provided Coverage B-Business Personal Property) See Schedule V Signs See Schedule'' '- ' . - .. . -, Valuable Papers and Records V See Schedule • Water Damage, Other Liquids,Powder or Molten Material Damage Included SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE SCHEDULE SCHEDULE `""' The coverages and corresponding limits shown below apply only to the described'premises as`shown. • Location Coverage Limit of Insurance number . . , , , , , 001 Accounts Receivable. . On Premises Limit $10,000:.........._..... . Off Premises Limit $5,000 Back-up of Sewer or Drain.,. $15,000 Money and Securities On Premises Limit • $10,0,00 . Off Premises Limit $5,000 . .. V . . '. Outdoor Property $5,000 ' Property of Others(applies only to those premises provided Coverage B-Business $2,500 V - Personal Property) Signs $5,000 . ' Policy Number:97-CP-D437-8 Page 3 of 6 Prepared:April 20,2021 ‘©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 001666 . . • . . . , . . . . AStateFarrne . ,. ., . . . , Location Coverage ,. .,Limit of Insurance number ' , , . - Valuable Papers and Records - . . . . . On Premises Limit , $10,000 . . . Off Premises Limit . $5,000 . . , . 003 Accounts Receivable , . , On Premises Limit , . I . $10,009,. ,, , , . • . . . . Off Premises Limit , $5,000 . . . . . . . , _ Back-up of Sewer or Drain , ' ' ' $15,000 Money and Securities ' ' . _ . . . . , - 0 On Premises Limit $10,000 , . , . Off Premises Limit $5 000 Outdoor Property ' $5 oao ..,. _ Property of Others(applies Only to those premises provided Coverage B-Business $2,500„ . _ Personal Property) Signs ." 1 . , . ,. • $5,P00 • . ,. . Valuable Papers and Records . . . . ' . On Premises Limit ,... $10,000 , Off Premises Limit - ' . . $5,000 .. . .. _ . . . SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY ... - s •• , , — - • • • -•• ., • ' The coverages and correspondinglimits shown below are the most we will pay Tegar.dless 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 .SECTION II-LOCATION SCHEDULE * . , . . Location Location of described premises • , number . . . 001 427 N RIVERSIDE AV . , ' .. . . MEDFORD OR 97501-4602 • . , 003 516 S FIR ST ,' ' . . . . MEDFORD OR 97501-3616 ',' , , ' • ... , ,. . . . . , . Policy Number:97-CP-D437-8 ' Page 4 of 6 Prepared:April 20,2021 ©Copyright,State Farm Mutual Automobile Insuranbe Company,2008 ' CMP-4000 . . ' U StateFarm® SECTION II-DEDUCTIBLES Property Damage: $250 y.'.. •-Other deductibles may apply-refer to policy., . . . SECTION II-LIABILITY § Coverage • Limit of Insurance . ,. „• . v,1 1-i Coverage L-Business Liability Per Occurrence $1,000,000' Coverage M-Medical Expenses ,i$5,000, One Any Person Damage to Premises Rented to You $300,000 ,. . , . Hired Auto Liability .. Included in Coverage L - . • • 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 welias'those issued subsequent tothe 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-4610.1 General Aggregate Limits of Insurance(Per Project) 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-4746.1 Hired Auto Liability - • CMP-4787 Waiver of Transfer of Rights of Recovery Against Others To Us CMP-4839 Loss Payable 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 INTBREST(S) Interest type: Owners,Lessees,or.Contractors(Schedul Endorsement number: CMP-4684.1 . Loan number: N/A • CITY OF ASHLAND ' 90'N Mountain Ave ' Ashland OR 97520-2014 • • Policy Number:97-CP-D437-8 • • ' Page 5 of 6 ' Prepared:April 20,2021, ;©Copyright,State Farm Mutual Automobile Insurance Company,2008 . ' CMP-4000 ' nM raj • • o StateFarm. • FULL NAMED INSURED • Named Insured: STRAW, DONALD E DBA FASHION FLOORS This policy is issued by the State Farm Fire and Casualty Company. •nr . 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. /me . . *pt 41. bet;y4m t . President Secretary • • Policy Number:97-CP-D437-8 • Page 6 of 6 Prepared:April 20,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 State Farm at CityLine . LI • PO Box 853925 Richardson, TX 75085.3925 6)0 State Farms State Farm Fire and Casualty Company CITY OF ASHLAND ' A stock company with home offices in Bloomington,.Illinois +� 90 N M ASHLANDOUNTAIN OR 97520AVE-2014 g , O • • Inland Marine Attaching 'Declaration Policy number: 97-CP-D437-8 Effective date: April 19, 2021 Policy period: 12 months 'Expiration date: February 18, 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: $374.00 . . ' . The above premium amount is included in the Policy Premium shown on the Declarations. FULL NAMED INSURED Named Insured: STRAW, DONALD E DBA FASHION FLOORS ' 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 FE-8754 Inland Marine Dealers-Service Form See below for schedule page with limits ATTACHING INLAND MARINE SCHEDULE PAGE Endorsement Coverage Limit of jnsurance 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-CP-D437-8 Page 1 of 2 Prepared:April 20,2021 ' ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • CIM Att Dec 3P OR.1 • 1009481 2002 153069 202 03-06-2021 FD-6007 ' 001668 • o *StateFarill Endorsement " Coverage, Limit of insurance Deductible amount Annual premium number' • .., . • FE-8754 Inland Marine Dealers-Service Form; $500 . '$374 Description of Property:FLOOR COVERINGS&TOOLS 1.Insureds property on customers premises limit. . . , . - $10,000 2.Customers property in insureds custody limit - - $10,000. 3.Property in transit limit $5,000 4.Tools,Servicing.Equipment, Spare Parts limit . . . . -$2,000. Other limits and exclusions may apply-refer to your,policy, 1`SS r . Policy Number:97-CP-D437-8 Page 2 of 2 Prepared:April 20,2021 ©Copyright,State Farm.Mutual Automobile Insurance Company,2006 . FD-6007