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HomeMy WebLinkAboutInsurance Certificate: Ashland Food Angels State Farm at CityLine U PO Box 853925 , Richardson,•:TX 75085-3925•. QC�a StäteFarrn® AT2 000680 1200 01 ''' State Farm Fire and Casualty Company CITY OF ASHLAND ITS OFFICERS& A stock company with home offibesin':Bloornington; Illinois ".!T. 20 E MAIN ST r.".'"*.. :i':. ASHLAND OR•97520-1814 • O 0 1�1rilili111111111111Iur111111�11iii�1liriiii11�11111� 11111'ilIi H G ws Renewal Declarations; ' ..,'4' . ..:,., .1,,,,-, czt,.-i :,,,..,1-,-..,.-,k-:. ' .„. „ • Policy number: 97-AA-C018-4 ' Effective date: July 29,2021 Policy period: 12 monthsExpiration date: July 29, 2022 4 - - - The policy period begins and ends.at 12:01 am standard time at the premises location. BUSINESSOWNERS POLICY n '� S :..'_i"."I ..l:1 :r- ''-.v'1;‘' ` -iC 5,r t.' :,. 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 pollcy_is terminated,'we will'give you and the ' Mortgagee/Lienholderwritten notice in:compliance.`with the policy'provisions Or*-as'required by law. . _._ NAMED INSURED ASHLAND FOOD ANGELS. . . . . .. _ .. . . . . 472 WALKER AVE . ASHLAND OR 97520-2324 - I ' ENTITY Nonprofit - _ . _ . . . • . . .-. . . . . . . .. , IMPORTANT MESSAGE(S) Notice - Information concerning changes in your policy language is included Please call youragent if you have any questions, 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: $465.00 ' Minimum Premium Discounts applied: Business Experience Rating - - Protective Devices - Years in Business Policy Number:97-AA-C018-4 Page 1 of 5 Prepared:May 21,2021 0 Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP Dec 3P OR.1 1009462 2003 153090 203 03-06-2021 CMP-4000 ' 002708 o9 State Farm® SECTION -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 001 472 WALKER AVE No Coverage $10,400 , 25% ASHLAND OR 97520-2324 *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: N/A ' • Coy B-Consumer Price Index: 263 SECTION I-DEDUCTIBLES BASIC DEDUCTIBLE , $1,000 - SPECIAL DEDUCTIBLES: _ 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 . 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 . Collapse Included -r ,, .,:,,..' 1;,, ; 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 r Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration $10,000 Glass Expenses Included ' Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a 10% replacement cost basis) . . Policy Number:97-AA-C018-4 Page 2 of 5 Prepared:May 21,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 . . " U 090StateFaren® CoverageLimit of Insurance ' ' s Money Orders and Counterfeit Money. • $1,000 . Money and Securities ,.' . , On Premises $5,000 ' S o - - Off Premises - . ., .. ... . - . • -. '$2,000 -. no - .. ,. Newly Acquired Business Personal Property(applies only if this policy provides Coverage B-Business $100,000- ' Personal Property) I • . Newly Acquired or Constructed,Buildings(applies only if this policy provides Coverage A-Buildings) $250,000 Ordinance or Law-Equipment Coverage " - Included ' OutdoorProperty .. • $5,000 . , Personal Effects(applies only to those premises provided Coverage B-Business Personal Property) $2,500 y Personal Property Off Premises $15,000 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) $2,500- . • S • Signs • • , . . , . $2,500, ' . . '. ' Valuable Papers and Records5 ., , . On Premises $10,000 •' ' ' Off Premises Water Damage, Other Liquids,Powder or Molten Material Damage Included, . SECTION I-EXTENSIONS OF cQVERAGE-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 Loss of Income and Extra Expense • 12 Months Actual Loss Sustained:- :'.'' ' SECTION II-LOCATION SCHEQULE Location Location'of described premises,• • . . number . 001 472 WALKER AVE ' ' v.. ASHLAND OR 97520-2324,, ' ' ' SECTION II-LIABILITY Coverage Limit of Insurance Coverage L-Business Liability Per Occurrence $1,000,000 .Policy Number:97-AA-C018-4 . . Page 3 of 5 Prepared:May 21,2021 0 Copyright,.State Farm Mutual Automobile Insurance Company,2008 CMP-4000 nm7no 090 State Farms Coverage • Limit of Insurance " Coverage M-Medical Expenses $5,000 Any One Person - . , • • • Damage to Premises Rented to You ' $300,000 • • . 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 amountof insurance we provide duringthe 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-4705.2 Loss of Income and Extra Expense " ' CMP-4709 Money and Securities , • • ' CMP-4798 Additional Insured=Grantor of Franchise • - . 'FD-6007 Inland Marine Attaching Declarations FE-3650 Actual Cash Value Endorsement` . " - - * FE-6999.3 Policyholder Disclosure Notice of Terrorism Insurance Coverage *New Form Attached SCHEDULE OF ADDITIONAL INTEREST(S) , Interest type: Grantor of Franchise - Endorsement number: CMP-4798 .. . . . . . .:- . . - . _ . Loan number: N/A CITY OF ASHLAND ITS OFFICERS&EMPLOYEES '' ` .1 1;•••:.;. .. ` .20EMain St; . 0 • . Ashland OR 97520-1814 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. 0 '' ' 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. _ „.•. _ . ._.. . _ . Pit e L d. Q. 4y.0-0 • President Secretary Policy Number:97-AA-C018-4 Page 4 of 5 Prepared:May 21,2021 '•©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 • . . u • 00 StateFarm® NOTICE TO,POLICYHOLDER: • For a comprehensive description of coverage and forms, please refer to your policy. ..' Policy changes requested before 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 amendeddeclarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. o . 0 Policy changes requested after the "Date Prepared"will be sent to you asan amendeddeclarations or as an endorsement to your policy. Billing for any additional premium for such,changes•will bewailed at a later data. If, during the past year, you've acquired any valuable property items; made any improvements to insured property, or have 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. Werecommend 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. Higher limits 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-C018-4 Page 5 of 5 Prepared:May 21,2021 ' 0 Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 002710 State Farm at CityLine U PO Box 853925 Richardson, TX 75085-3925 O StateFarm® . State Farm Fire and Casualty Compahy 1 CITY OF ASHLAND ITS OFFICERS & A stock company with home offices in Bloomington, Illinois ;b:? 20EMAIN ST ASHLAND OR 97520-1814 S Inland Marine Attaching Declarations Policy number: 97-AA-C018-4 Effective date: July 29, 2021 Policy period: 12 months Expiration date: July 29,2022 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, 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 MARINO$cHEDUL;E RAGE . 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-AA-C018-4 • Page 1 of 1 Prepared:May 21,2021 ©Copyright,State Farm Mutual AutomobileInsurance Company,2008 CIM Aft Dec 3P OR.1 1009481 2002 153089 202 03-06-2021 FD-6007 002711 - � CMP-4798 Page 1 of THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. !kik"' -ADDITIONAL INSURED—GRANTOR OF FRANCHISE This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM coo SCHEDULE Policy Number: 97-AA-C018-4 Named Insured:. ASHLAND FOOD.ANGELS 472 WALKER AVE ASHLAND OR 97520-2324 Name And Address,Of Additional Insured Person Or Organization: . • CITY OF ASHLAND ITS OFFICERS &EMPLOYEES 20EMain St " Ashland OR 97520-1814 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 with respect to their liability as grantor of a franchise to you, 2. Any insurance provided to the'additional insured shall only apply withrespect 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 insurancecarried by the additional insured shall be noncontributory with respect to coverage provided by you. ' All other policy provisions apply. • CMP-4798 151377 06-02-2017 ©,Copyright, State Farm Mutual.Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.