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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald E DBA Fashion FL State Farm at CityLine ,.11 PO Box 853925 " Richardson, TX 75085-3925 CFO State arm& AT1. 000382 1200.01 . State Farm Fire and Casualty Company CITY OF ASHLAND A stock company,With home:offices in BldoMirigton;lllindis 90 N MOUNTAIN AVE , I ASHLAND OR 97520-2014 . S . . .. Fa rlillrllrlllllllnllllllrlllrl iliil"Iillllllrl'llliiiiiiIFII'Il . , . ' , . . .. . . ' Amen d 'Declarations , -- - ------ - . j...r.1-':•' ' Policy number: 97-CP-D437-8 • .. . Effective date: July-15, 20`21 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 POLICY Automatic renewal -If the State Farm®policy period is shown as 12 months; this policy will be renewed automatically subjectto'the - premiums,.rules and,forms.in effectfoL each_succeeding,policy period Ifrthis pollcyas#terminated, .we4will„give you and;the _- _” _ . Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. '' NAMED INSURED ' ` STRAW, DONALD E DBA FASHION FL ' '+_ : . - .. . r° ' _ r.., «; ' . . - 1 ' .;;-:::,-,i- 427 N RIVERSIDE AVE , _ . , , MEDFORD OR 9750.1-4602., . •` ENTITY Sole'Proprietorship;Individual ', 1 , rE Irri , , REASONS FOlt DECLARATIONS • • r. ,. ;. Yo'ur'policy is`amended effective'July 15,'2021 du_e: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 es-described in this Declarations: 1 • Total Premium: $4,254.00` Discounts applied: ' . - ' . ' Business Experience Rating Renewal Discount , , , , Protective Devices - - Years in Business ' Policy Number:97-CP-D437-8 Page 1 of 6 Prepared:July 15,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 . _ CMP Dec 3P OR.1 1009482 2003.153090 203 04-10-2021 CMP-4000 • nni Fne . '00State Faring' 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). Cov A-Inflation Coverage Index: 190.2 Coy B-Consumer Price Index: • 260,4 SECTION I-DEDUCTIBLES BASIC DEDUCTIBLE $1,000. ,:- j ,., • P. SPECIAL DEDUCTIBLES: Employee Dishonesty: $250. Equipment Breakdown: $1,000 Money and Securities: $250 Other deductibles may apply-refer to policy, SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-EACH DESCRIBED PREMISES • r, • 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 ReceivableSee Schedule ':s':I N `. '.. : ' Arson 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:July 15,2021 . . ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 •' .,. 0Q StateFarm Coverage Limit of Insurance 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 $ 1,758 Money and Securities See Schedule `- 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 provided Coverage A-Buildings) $250,000 . , Ordinance or Law-Equipment Coverage Included Outdoor Property See Schedule 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 Property 30 days Property of Others(applies only to those premises provided Coverage B-Business Personal Property) See Schedule Signs See Schedule c, Valuable Papers and Records See Schedule Water Damage, Other Liquids,Powder or Molten Material Damage Included _ -_ . SECTION I-.EXTENSIONS OF COVERAGE=LIMIT OF INSURANCE'-SCHEDULE"` ' ' The coverages and corresponding limits shown below apply only to the described prernises as shown. ' Location Coverage .Limit of Insurance number 001 Accounts Receivable On Premises Limit '$1.0,000 -. Off.Premises Limit $5;000 Back-up of Sewer or Drain . . . $15,000 Money and Securities On Premises Limit $10,000 •• Off Premises Limit $5,000 Outdoor Property - $5,000 ` Property of Others(applies only to those premises provided Coverage B-Business $2,500 - • - Personal Property) Signs $5,000 ' Policy Number:97-CP-D437-8 Page 3 of 6 Prepared:July 15,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 001510 090 StateFarm® 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 $10,000 Off Premises Limit $5,000 - _ Back-up of Sewer or Drain " ' _ . . $15,000 " " Money and Securities ' On Premises Limit' $10,000 Off Premises Limit ' ' ` ` ' s•' $5,000 Outdoor Property ' ' $5,000 , Property of Others(applies only to those premises provided Coverage B-Business $2,500 Personal Property) ,j . Signs_ $5,000 , Valuable Papers and Records. • ' . , On Premises Limit $10,000 Off Premises Limit $5,000 SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY,,„ ,; .; ; . ,, .,.• 4 . ., ; , • The coverages and corresponding limits, shown.beloware;the most we•will pay regardless ofthe 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 FIRST. MEDFORD OR 97501-3616 Policy Number:97-CP-D437-8 0 , . •Page 4 of 6 • Prepared:July 15,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 0 ' Li k ; 4OPO StateFarm®. SECTION II-DEDUCTIBLES = a t' '` 'Property Damage: $250 • {-Other deductibles may apply-refer to policy. SECTION II-LIABILITY '' S Coverage Limit of Insurance ' ', • ' ` :-','.: , CI)o 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 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 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-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 INTEREST(S) , Interest type: Owners,Lessees, or Contractors(Schedul Endorsement number: CMP-4684.1 Loan number: NIA • CITY OF ASHLAND 90 N Mountain Ave . Ashland OR 97520-2014 • . • • Policy Number:97-CP-D437-8 Page 5 of 6 Prepared:July 15,2021 . .©Copyright,State Farm Mutual Automobile Insurance Company,2008. CMP-4000 001511 , • oPo StateFarm. FULL NAMED INSURED Named Insured: STRAW, DONALD E DBA FASHION FLOORS 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 Farrh..Firo and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinoia. President • • -- Secretary •I • • , • , a .2'1% I ‘,* • . • I • , . '•• • • Policy Number.97-CP-D437-8 Page 6 of 6 Prepared:July 15,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 State Farm at CityLine PO Box 853925 Richardson; TX 75085=3925 _ 820 State Faring. State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington,,Illinois 90 N MOUNTAIN-AVE - . - --- ASHLAND OR 97520-2014 O 0 (no Inland Marine Attaching Declarations • Policy number: 97-CP-D437-8, Effective date: July 15, 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 formsand 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 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-CP-D437-8 ' ' Page 1 of 2 Prepared:.July 15,2021 ©Copyright,State Farm Mutual•Automobile Insurance Company,2008 CIM Att Dec 3P OR.1 1009481 2002 153089.202 03.06=2021 FD-6007 001512 • StateFarna® '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.Idols,Servicing Equipment, Spare Parts limit • $2,000 - Other limits and exclusions may apply-refer to your policy. • • • • • • •ry ..,. 4•, • • • ... .- e }�,a •r • • • Policy Number 97-CP-D437-8 Page 2 of 2 Prepared:July 15,2021 ©Copyright,State Farm-Mutual Automobile Insurance Company,2008 FD-6007 • •