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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald E dba Fashion Fl (2) State Farm at CityLine PO Box 853925 Richardson; TX 75085-3925 090 StateFal m AT1 000376 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND. A stock company with home bffi'bes in:Bloorriington_Illinois . 90 N MOUNTAIN AVE ASHLAND OR 97520-2014. • ' (.17 lI'lh1IIlIIIIII'IIIIIII"IIII'II'IIIIIIIII1lllnli :..-.. Amended Declarations ( , :. • • , _ •. Policy number: 97-CP-D437-8 Effective date: July 7, 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 POLICY ' Automatic renewal -If the State Farm®policy period is shown as 12 months, this policywill be renewed automaticallysubjecrto 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-noticeln compliance with the policy provisions'orasrequired.by`law:- - : NAMED INSURED • STRAW, DONALD'E DBA FASHION FL }yi. ! _ , ay ., "! :', { ., . ,;; E . ,I: ,l , - 427 N RIVERSIDE AVE, ' ' ' . MEDFORD.OR 97501-4602 ENTITY } Sole Proprietorship-Individual - _ REASONS FOR DECLARATIONS • Your policy is amended effective:July 7, 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 policy as described in this Declarations. Total Premium: $4,201.00 0 Discounts applied: . Business Experience Rating Renewal Discount Protective Devices -' • . . Years in Business . Policy Number:97-CP-D437-8 Page 1 of 6 Prepared:July 8,2021 '©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP Dec 3P OR.1 1009462 2003 153090 203 04-10-2021 CMP-4000 ' 001470 00 State Farms SECTION I-PROPERTY SCHEDULE.-BLANKET Limitof 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 Cov B-Consumer Price Index: 260.4 SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE. $1,000 t , <<.t. 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 • •• ' 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 ?' '.a, - Arson.Reward Back-up of Sewer or Drain See Schedule Collapse Included t. ' • 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 8,2021 . ©Copyriight,State Farm Mutual Automobile.Insurance Company,2008 CMP-4000 ' u Q State Fame) Coverage Limit of Insurance • ra . 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 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 provides 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 Property30 days Property of Others(applies only to those premises provided Coverage B-Business Personal Property) See Schedule . SignsSee Schedule• • Valuable Papers and Records :. See Schedule - ' Water Damage, Other Liquids,Powder or Molten Material Damage Included' ' SECTION I-EXTENSIONS OF COVERAGE-LIMITOF INSURANCE'=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 ty -ii •);. =‘ti'a.. tl,. -?: 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 8,2021 ©Copyright,State Farrn Mutual Automobile Insurance Company,2008 . CMP-4000 • 001471 . . ' • .. StateFarrn® . Location L 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 PremisesLimit'-' y , $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 Valuable Papers and Records .. ; , On Premises Limit, • ' $10,000 " Off Premises Limit $5,000 ,,.- SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-,PER POLICY:. ,,.,•,,,,;e,.,, , „3 .,u,,: • }. The coverages and corresponding limits shown:below arethe 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 ..',..p 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.RIVERSIDEAV - MEDFORD OR 97501-4602 • ' 003 516 S:FIR ST ' MEDFORD OR 97501-3616 Policy Number:97-CP-D437-B - Page 4 of 6 Prepared:July 8,2021 ©Copyright,State Farm Mutual Automobile Insurance Company;2008 , .. . CMP-4000 ,. 00 State Farina SECTION II-DEDUCTIBLES • ME Property Damage: $250 FWA Other deductibles may apply-refer to policy. . • • SECTION II-LIABILITY 0 Coverage Limit of Insurance 3,,; ;it, • 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: N/A CITY OF ASHLAND 90 N Mountain Ave Ashland OR 97520-2014 • Policy Number:97-CP-D437-8 Page 5 of 6 Prepared:July 8,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 - CMP-4000 ' 001472 ' :: .. .: . StateFarth 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 Farm Fire and Casualty Company has caused this policy to be signed by its P`resident and Secretary at_ Bloomington, Illinois. , ////10'—L-e `Q.:71. ' "' . President- - -- - - - -Secretary - ' -- • Policy Number:97-CP-D437-B Page 6 of 6 'Prepared:July 8,2021 ©Copyright,State Farm Mutual Automobile Insurance Company:2006 CMP-4000 State Farm at CityLine L' PO Box 853925 Richardson, TX 75085.3925 c Oc)S d e arme 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,- • 7520-2014, t' g O c'T)a Inland Marine Attaching Declarations Policy number: 97-CP-D437-8 Effective date: July 7, 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 Marie 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 8,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008. CIM Att Dec 3P OR.1 1009481 2602 153089 202 03.06-2021 FD-6007 001473 o State Farmo 'Endorsement. Coverage Limit of insurance Deductible amount Annual premium number rs, 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. ', • •."ir•u Z}'C" .i1.t er1A 1n .• • Policy Number:97-CP-D437-8 '. Page 2 of 2 Prepared:July 8,2021 ©Copyright,State Farm Mutual.Automobile Insurance Company,2008 •. FD-6007...