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HomeMy WebLinkAboutInsurance Certificate: Better View LLC DBA Farrells State Farm at CityLine u PO Box 853925 Richardson, TX 75085-3925 090 State earn® AT2 001040 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND FLEET SERVICES A stock company with home offices.in Bloomington,'Illinois '.F.:•t 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 0 o I I I I I I I'I'I I I I I I l l I I l I l I l I'I I I I I I I I I'I I I I I I I I'I I I I l l"I I'l l'I I I I I ' too Renewal Declarations • , - . . . . : , .i.., . .... . ,. ,...,... Policy number: 97-AA-B135-1 Effective date: June 27, 2021 Policy period: 12 months Expiration date: June 27, 2022 " 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/Lienholder written notice in cornpliance'with'the policy4tr'ovisions or aerequiredbY law.. • ` •' S ' ' 'v. - __ NAMED INSURED BETTER VIEW LLC DBA FARRELL'S 229 S FRONT ST MEDFORD OR 97501-7263 • ENTITY Limited Liability Company IMPORTANT MESSAGE(S) . Notice - Information concerning changes in your policy language is included:Please'call your agent if you have any questions. - S 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: $3,740.00 . S • Discounts applied: - - . Business Experience Rating Renewal Discount Protective Devices . Years in Business • • Policy Number:97-AA-B135-1 Page 1 of 5 Prepared:April 30,2021 ©Copyright,State'Farm Mutual Automobile Insurance Company,2008 CMP Dec 3P OR.1 1009482 2003 153090 203 03-06.2021 CMP-4000 004499 • • . `oo StateFarrrr 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 $608,200 $77,800, 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 INDEX(ES) • Coy A-Inflation Coverage Index: 192.9 Coy B-Consumer Price Index: 263 ' SECTION I—DEDUCTIBLES • BASIC DEDUCTIBLE , $500,, ; , . ; , , .' .ti. SPECIAL DEDUCTIBLES: i Employee Dishonesty: $250 , ' - , • Equipment Breakdown: $500 Garagekeepers:Collision: $500 • Garagekeepers-Comprehensive: $250 : -, . •; Money and Securities: $250 Other deductibles'niay 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,~,.l,. , 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 I. _ ' Accounts Receivable _, , • On Premises $10,000 . ' , Off Premises . $5,000 • ,,•: , ,c. , : % .:: •. • Arson Reward.._:..... .. ...... 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 s. 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 30,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008' " CMP-4000 • U 09 StateFar�ne Coverage Limit of Insurance • ' - . . . .. 1 ' k Fire Department Service Charge $5,000 • ' ' . Fire Extinguisher Systems Recharge Expense ,$5,000 ' _, . •` ' Forgery or Alteration $10,000 . a c„:?, Garagekeepers Insurance-Direct Coverage $25,000 1-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 providesCoverage-B Business $100,000 • • Personal Property) ' Newly Acquired or Constructed Buildings(applies only if this policy provides Coverage A-Buildings) .$250,000 - " • 1 - • Ordinance or Law-Equipment Coverage • • Included 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 - ' ' r ' $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 ' $10,000 • . . .. Off Premises 1. '. •$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 Premise's shown in these Declarations. ' . . c , CoverageLimit,of Insurance Employee Dishonesty ` ' $1.0,000. . - ' ' Loss of Income and Extra Expense 12 Months Actual Loss Sustained .` Policy Number:97-AA-B135-1 , Page 3 of 5 Prepared:April 30,2021 ' • ©Copyright,State Farm Mutual Automobile Insurance Company,2008• . CMP-4000 . • 004500 QQ Std `i t rrne SECTION II-LOCATION SCHEDUTA 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 ;.: •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 thoseissued subsequent to the issuance of this policy. ' .- " , FORMS AND 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- r 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 „-; _ ,, , , • ,i„s•.1 ,;-,;,r,-; . -. . - , ,r-,,-;-:,:::,, CMP-4706 Back-up of Sewer or Drain CMP-4709. • Money.and Securities I, , - , • , 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 30,2021 ©Copyright,State Farr)Mutual Automobile Insurance Company,2008 CMP-4000 ' w Qo StateFarm® * FE-6999.3 Policyholder Disclosure Notice of Terrorism Insurance Coverage *New Form Attached 4.'14 SCHEDULE OF ADDITIONAL INTEREST(S) Interest type: Owners,Lessees,or Contractors(Schedul Endorsement number: CMP-4684.1 § Loan number: N/A CITY OF ASHLAND FLEET SERVICES/FACILITIES MAINTENANCE "0 90 N Mountain Ave 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 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. /frite46.49:777-4;t•-tD ' *mit,b1.1/44.4414., President Secretary • NOTICE TO POLICYHOLDER: For a comprehensive description of coverage and forms, please refer to your policy. Policy changes requestedbefore the "Date Prepared",which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached Ito this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared"will be sent to you as an arnendeddeclarations or as an endorsement to your policy. Billing for any additional premium for such changes will be.mailed at a later date. If, during the past year, you've.acquired any valuable property items, made any improvements-to insuredproperty, orhave any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. Your coverage amount.... It is up to you to choose the coverage and limits that meet your needs. We recommend that you purchase a coverage limit equal to the estimated replacement cost of your structure. Replacement cost estimates are available from building contractors and replacement cost appraisers, or, your agent can provide an estimate from Xactware, Inc. using information you provide about your structure. State Farm does not guarantee that any estimate will be the actual future cost to rebuild your structure. Higherlimits are available at higher premiums. Lower limits are also available, as long as the amount of coverage meets our underwriting requirements. We encourage you to periodically review your coverages and limits with your agent and to notify us of any changes or additions to your structure. Policy Number:97-AA-8135-1 Page 5 of 5 Prepared:April 30,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 004501 State Farm at CityLine LI PO Box 853925 • • Richardson, TX 75085-3925 090 State Farm® State Farm Fire and.casualty Company CITY OF ASHLAND FLEET SERVICES A stock company with home offices in Bloomington, Illinois tidi 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 • •0 0 th 0 Inland Marine Attaching Declarations.' • Policy number: 97-AA-B135-1 Effective date:.June 27, 2021 Policy period: 12 months Expiration date: June 27, 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, MortgageefLienholder 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 0 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-8135-1 0 • Page 1 of 2 Prepared:April 30,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • • CIM Att Dec 3P OR.1 • 1009481 2002 153088 202 03-06-2021 FD-6007 . • 004502 • • 690'Stag ® • Other limits and exclusions may apply-refer to your policy. ' •• • ji Policy Number:97-AA-B135-1 Page 2 of 2 ' Prepared:April 30,2021 ©Copyright,State Farm Mutual Automobile InsuranceCompany,2008 FD-6007 CMP-4684.1 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY..PLEASE READ IT CAREFULLY. • 411 -ADDITIONAL INSURED—OWNERS, LESSEES, OR CONTRACTORS(Scheduled) This endorsement modifies insurance provided under the following: § BUSINESSOWNERS,COVERAGE FORM . 0 SCHEDULE Policy Number: 97-AA-B135-1 Named Insured: BETTER VIEW LLC DBA FARRELL'S GLASS SERVICE 90 N Mountain Ave Ashland.OR 97520-2014 Name And Address Of Additional Insured Person Or Organization: CITY OF ASHLAND FLEET SERVICES/FACILITIES MAINTENANCE • 90 N Mountain Ave • Ashland OR 97520-2014 1. SECTION II —WHO IS.AN INSURED of,SECTION II —LIABILITY is amended to include, as an additional insured, any person. or organization shown in the Schedule, but only: a. Ongoing Operations With respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused by your ongoing operations for that additional insured and only to the extent that such "bodily injury", "property damage" or "personal and advertising injury" is caused by your negligence or the negligence of those performing operations on your behalf; or b. Products-Completed Operations To the extent that the liability for "bodily injury" or "property damage" is caused by "your work" performed for ghat additional insured and included in the"products-completed operations hazard".. 2. Any insurance provided to the additional insured shall only apply with respect to a claim made or a"suit" brought for damages for which you are provided coverage. 3: Primary Insurance 'The-insurance afforded the additional insured shall be primary insurance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. All other policy provisions apply. • • CMP-4684.1 155042 03-20-2019 ©, Copyright, State Farm Mutual Automobile Insurance.Company, 2018 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. • • 004503