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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald E. DBA Fashion Fl State Farm at CityLine PO Box 853925 Richardson, TX,75085-3925 090 Q tateFarr® AT1 000413 1200 01 State Farm Fire and Casualty Company ,thr„ CITY OF ASHLAND . A stock company:with home"offices:in Bloomington;,Illinois,,• Kig 90 N MOUNTAIN AV ASHLAND OR 97520-E 2014 C C IIIII'IIIIIIIII11111IIIII'IIII'IIIIIIIIII'IIIIItII111111IllIlill • - mo . Amended Decl.ar tions t $ 4 ! ,. , • R4 + Policy number 97-CP-D437=8 Effective dateJuly 16.2021:` `` ' 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 policy will be renewed automatically subject to the premiums, rules and forms in,effeAfor each succeeding policy period. If this policy„ls terminated, we well give you MortgageeILienhblder'written-notide in compliance wlth the pollcy°or'ovlsibns oras requiletlby law: -” • " NAMED INSURED STRAW, DONALD E DBA FASHION FL:: . . r• .,, , • ' 427 N RIVERSIDE AVE MEDFORD OR 97501-4602 ENTITY. • Sole Proprietorship-Individual. REASONS FOR DECLARATIONS ; Your ollc is'amended''effective Jul r 16;2021 due to some'recent' olic''clian es ou re nested:Enclosed is:a co of "our new P Y Y , p Y 9 Y. Q py Y 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: $4,254.00 • • Discounts applied: Business Experience Rating " Renewal Discount Protective Devices Years in Business Policy Number:97-CP-D437-B Page 1 of 6 Prepared:July 16,2021 ©Copyright,State Farm Mutual Automobile,lnsurance Company,2008 CMP Dec 3P OR.1 1009482 2003 153090 203 04,10-2021 CMP-4000 001621 0"°c;StateFarmm 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 inthe 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: , . i' Employee Dishonesty: • . $250 . , • Equipment Breakdown: $1,000 Money and Securities: $250 . Other deductibles may apply-refer to policy. • ; ,r• r 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 y t '`' ' ' Arson Reward , ' ' • ' " • $5,000 Back-up of Sewer or Drain See Schedule ' Collapse s 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 16,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 cMP•4000 • ' • L., QC StateFarm'® Coverage Limit of Insurance • ,. , }: '''' Glass Expenses . - Included - - , kcal{ Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a 10% • - - replacement cost basis) S Money Orders and Counterfeit Money $1,000 t „. o Money and SecuritiesSee 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 Property • ' 30 days ' ' ' Property of Others(applies only to those premises provided Coverage B-Business Personal Property) See Schedule , Signs See Schedule - ' ' 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 premises as.shouun. ' Location • Coverage Limit of Insurance number ' 001 Accounts Receivable , On Premises Limit . $10,000 Off,Premises Limit $5,000 . • Back-up or Sewer or Drain - - $15,000. Money and Securities V • 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 V Policy Number:97-CP-D437-8 V , Page 3 of 6 Prepared:July 16,2021 ' ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 , V 001622 Star '►® 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 .$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;-:PERPOLICV, , .- ,,'1,,i . ,.- ; ' ' ' , The coverages and corresponding limits:shown.below are,the most 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 ' Loss of Income and Extra Expense 12.Months Actual Loss'Sustained •Utility Interruption-Loss of Income $10,000 • SECTION II-LOCATION SCHEDULE . . Location - Locationof described.premises _ number• 001 427 N RIVERSIDE AV MEDFORD OR 975014602 ' - 003 516-SFIR ST„ . . - MEDFORD OR 97501-3616 ' ' ' Policy Number:97-CP-D437-8 . ' Page 4 of 6 Prepared:July 16,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 ; u " oa State Farms SECTION II-DEDUCTIBLES. . fiNM Property Damage: $250 Other deductibles may apply refer to policy. SECTION II-LIABILITY Coverage Limit of Insurance t. .,:,• . -�. '?`'' ,;:�' 1-6$ Coverage L-Business Liability Per Occurrence_, . .. , • !.1 :• ,' .$1,000,000. Coverage M-Medical Expenses ' $5,000 Any One Person Damage to Premises Rented to You $300,000 Hired Auto LiabilityIncluded 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-4663.1 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-4635 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-0437-8 Page'5 of 6 Prepared:July 16,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008, ' CMP-4000 . 001623 -, ' ate StateFarm . .-... ! -,-. ,, . . , .,f • ' ,.-. FULL NAMED INSURED . . Named Insured: STRAW, DONALD E DBA FASHION FLOORS This policy is issued by the State Farm Fire and Casualty Company. .. ,.... ',A; ••.':'-• •, PARTICIPATING POLICY ; . ,i,, .. ... •.. You are entitled to participate in a distributionof 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 arid`Ca'sualty dompany has caused this policy to be signed by its President and Secretaryat Bloomington, Illinois. . . . . . . .. f.e4r-0 President - . " ' . - - Secretary , , • . • . _ . , , . , „ . • . , ., , , . • • . , , ,,. . .-• . „. . , , . , . . . • . , . , . '..',....'•:... \,- r'.._.,•'-',':ie,i' ';'. 2-2.'' , • ' . . , . . . PoliCy Number:97-CP-D437-8 Page 6 of 6' Prepared:July 16,2021 @ Copyright,State Farm Mutual Automobile Insurance Company,2008 GMP-4000 • A '', 1 •1 . state Farm.at CityLine • PO Box'853925 : Richardson, TX 75085-3925 870 State Farms State Farm Fire and Casualty Company CITY OF ASHLAND Astock company with home offices in Bloomington,'Illinois 90 N MOUNTAIN AVE . . _ ._ ASHLAND OR 97520-2014 1,7i 8 Inland Marine Attaching Declarations • Policy number: 97-CP-D437-8 . Effective date: July 16, 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 willbe'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 MortgageeiLienholder-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 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-0437-B Page 1 of 2 Prepared:July 16,2021 ©Copyright,State Farm Mutual Automobile•Insurance Company,2008 CIM Att Dec 3P OR.1 1009481 2002 153089 202 03-05-2021 • FD-6007 • 001624 — • 0o StateF rnr 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, , icing Equi • • • Number:97-CP-0437-8 , Page 2 of 2 Prepared:July 16,2021 • 0Copyright,State Farm Mutual Automobile Insurance Company;2008 • FD-6007 -