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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald E. DBA Fashion Fl (2) State Farm at CityLine LJ PO Box 853925 Richardson;,TX 75085-3925. CF• O State l"r aIp m AT1 000320 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND A stock company:with-homeoffioes in Blbomingtonj:iillinois 90 N MOUNTAIN AVE • ASHLAND OR 97520-2014 • 11111i1I1I1'itn11111111111'1Illnn11IuIlri111'11l'lllirl11111 r •, • ':Amended Declarations , „ . • , lr. H1; {i, � Policy'number: 97-CP-D437-8 - Effective date, A'ugust'2, 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:effect=for each succeedingpolicy.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. NAMED INSURED . STRAW, DONALD E DBA FASHION FL_ •. '!._;z:1/!t:;,,. :, _. -1;?' . + . . :; • ;s. ; 427 N RIVERSIDE AVE; MEDFORD OR.,97501-4602 ENTITY • Sole.Proprietorship=Individual REASONS FOR DECLARATIONS.", Yourr�•olic is,amended effective August 2,2021 due to some recent olic changes you re' uested Enclosed is a copyof our'new., P Y• 9 p Y 9 q y 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: $4,267.00 . ' Discounts applied: , Business Experience Rating Renewal Discount . Protective Devices -Years in Business - Policy Number:97-CP-D437-8 Page 1,of.6 Prepared:August 5,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP Dec 3P OR.1 1009482 2003 153090203 04-10.2021 CMP-4000 ' nnIncc • a.StathFa °i1I'1® 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)• ; . • Coy A-Inflation Coverage Index: r .190.2 Coy B-Consumer Price Index: 260.4 SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE $1,000 i SPECIAL DEDUCTIBLES: ::r; , •. Employee Dishonesty: $250 . . Equipment Breakdown: $1,000 ' Money and Securities: $250 " • Other deductibles may apply-refer to policy, . Y g, 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 showh below; but has"Included" indicated, refer to that policy provision for an explanation of that coverage. ; Coverage Limit of Insurance • • •' - Accounts Receivable See Schedule F `'' '': i=`• Arson Reward r $5;000' Back-up of Sewer or Drain ' See.Schedule Collapse Included a. 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:August 5,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 ., CMP-4000 ' ' U State Farm) Coverage - ' ' Limit of Insurance .r , Glass Expenses Included'- Increased Cost of Construction and Demolition Costs(applies only when buildings areinsured on a '..' 10% " ' '. '' ... replacement cost basis) ' Money Orders and Counterfeit Money $1,000 - o _ o Money and Securities See Schedule Newly Acquired Business Personal Property(applies Only if this policy provides Coverage B-Business $100,000 '` - • Personal Pro ty) _. ProperP • 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 Signs See Schedule '' Valuable Papers and Records _ See Schedule " . Water Damage, Other Liquids,Powder or Molten Material Damage Included p,. r'-.:.r ,P,1�,,r'll- iii•'• $ ...t!"-..'".. ''. .;:', SL,..'../1 .: r.r^ J. ..,r "". SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE=SCHEDULE " ` ` The coverages and corresponding'limits'shown belOW apply only to the described premises'as sho'n. ' ' `'•' - ' - ' Location Coverage ,' Limit of Insurance number 001 Accounts Receivable 11. ' 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 '' - - • ' • Policy Number:97-CP-D437-8 ; Page 3 of 6. Prepared:August 5,2021 ©Copyright,State Farm Mutual Automobile Insurance Company(2008 CMP-4000 . nn12Fn • - CDo 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 ,..� . • Off Premises Limit : ' $5,000 Back-up of Sewer or Drain $15,000' ' Money and Securities . On Premises Limit' .. $10,000 . . Off Premises Limit .. , `..: J $5,000 ' Outdoor`Property LY,` .:•:. , $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,! ,tar 4"'. S- 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 Dependent Property-Loss ofilncome $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 r MEDFORD OR 97501-4602" " _ " .. - • " 003 516 S FIRST ' MEDFORD OR 97501-3616 • Policy Number 97-CP-D437-8, Page 4 of 6 Prepared:August 5,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000' • u oo StateFarm® SECTION II-DEDUCTIBLES - 'Property Damage: $250 It`Other deductibles may apply-refer to policy. ,• " ' •• SECTION II-LIABILITY . § Coverage Limit of Insurance h:': ' • iv! • $ 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 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 BUSINESSOVVNERS 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_o16 Prepared:August 5,2021 ©.Copyright,State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 • nn 957 ` A 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 Farm Fire and Casualty Company has caused this.policy to be signed by its President and Secretary at Bloomington, Illinois. *ty.44,*. iwiezeiLQ.77-44...„0 President. Secretary ' - - . . • • t . • Policy Number:97-CP-D437-8 Page 6 of 6 Prepared:August 5,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 State Farm at CityLine. u PO Box 853925 Richardson,;TX 75085-3925 0C)0 StateFarmo State Farm Fire and.Casualty, Company CITY OF ASHLAND A stock company with home offices in Bloomington,,Illinois 90 N MOUNTAIN AVE _ . . 1, ASHLAND OR 97520-2014 =• . O • Inland Marine Attaching Declarations Policy number: 97-CP-D437-8 Effective date: August 2, 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 thispolicy 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 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:August 5,2021 ©Copyright,.State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR.1 1009461 2002 153089 202.03-06.2021 FD-6007 001258 ' .:0o StateFarm® Endorsement ' 'Coverage Limit of insurance- Deductible amount Annual premium number „ . :: '; - FE-t8754 Inland Marine Dealers-Service Form $500 c- $374 .'• ,"s ' 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 andexclusions may apply-refer to your policy. , ' . -- . • - . 1, 1l:. if'17, • ' • .1x1,1, ''1. . I?,'ir ,. 'f, ..1.';..:1‘.1k) :t. h i ". ,i t.' . • , .. ,. til;d4C. ''•, .'- p•:li!i"'•', it: is ..'-t? n"c4 • Policy Number:97=CP-D437-8 „ • - Page 2 of 2 Prepared:August 5,2021 ©Copyright,State Farm Mutual Automobile Insurance.Company,2008 ' Fb-6007 . . .