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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald E. DBA Fashion FL (3) State Farm at CityLine LI • PO Box 853925 Richardson, TX 75065-3925 6 p0 State Farm ' AT1 000676 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with'home:offices.in Bloomington;.Illinois 90 N MOUNTAIN AVE :I ASHLAND OR 97520-2014 a yo$ II SII �� II I I I I�II� III. IhI I III II 111111 VIII I I I II I I I I I III II I IIII I • • • 'Amended . Declarations • Policy number: 97-CP-D437-8 Effective,date:'August 12, 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, rulesand forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the • ' MorfgageelLienholder written-notice iri compliance with the-policy provisions or as required by law:: NAMED INSURED " STRAW, DONALD E DBA FASHION FL • 427 N RIVERSIDE AVE. MEDFORD OR 97501-4602 ENTITY Sole Proprietorship-Individual REASONS FOR DECLARATIONS Your policy is amended effective August 12,2021 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: $4,275.00 Discounts applied: Business Experience Rating Renewal Discount ' , Protective Devices 0 • Years in Business ' Policy Number:97-CP-D437-8 • 'Page 1 of 6 Prepared:August 19,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008. CMP Dec 3P OR.1 1009482 2003 153090 203 04-10-2021 CMP-4000 • 002637 090 StateFarme SECTION I-PROPERTY SCHEDULE-BLANKET • " Limit of insurance* - CoverageA-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 51.6 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:• ., ,190:2. . Coy B Consumer Price Index: ' 260.4 , SECTION I-DEDUCTIBLES BASIC DEDUCTIBLE $1,000 SPECIAL DEDUCTIBLES: : : . - : Employee Dishonesty: $250- , ; - • , Equipment Breakdown: $1,000 . ' Money and Securities: $250 • • Other deductibles may apply-refer to policy. i, ,•,•.,' . ' 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 , }' '' Arson Reward $5,000 • 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:August 19,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 . GMP-4000 • u • Q Stat�Farm® Coverage Limit of Insurance .• • - 'i• 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 6—,sic 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 Property .30 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•LIMIT OF INSURANCE='SCHEDULE'• • ` -• ":% • '411-' '7'''= The coverages and corresponding lihiits shown below apply only to the described premises as shown.. - ' • • ' . - Location Coverage Limit of Insurance number' , . 001 Accounts Receivable '• ' . On_Premises.Unit--_.::_,......... • ........_-- -- $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:August 19,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4030 .. 002638 w . . , 090Sta(eF..rm6 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-PER POLICY, s:.-„.:,, .., ,;,,1_ -, ,r, ,• ,; ' 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 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 FIR ST .. .. -. . MEDFORD OR 97501-3616 . Policy Number:97-CP-D437-8 . , ' • Page 4 of 6 Prepared:August 19,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,•2008 CMP-4000 . • u • o StateFarm SECTION II-DEDUCTIBLES ' •-J� •Property Damage:. $250 Other deductibles may apply refer to policy, SECTION II-LIABILITY Coverage Limit of Insurance Coverage Ls,Business Liability,Per Occurrence, ` • r' $1;000,000 r; 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:August 19,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 002639 • • SfateFarm® 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 companyas determined by our'Board of Directors in accordance ' with the Company's Articles of Incorporation, as amended. In.Witness Whereof, the State.Farni Fire and Casualty Company has caused this policy.to.'be.signed.by its.President and Secretary at Bloomington, Illinois. President . • Secretary • • • • Policy Number:97-CP-D437-8 • . Page 6 of 6 Prepared:August 19,2021 ©Copyright;State Farm'Mutual Automobile Insurance Company,2008 CMP-4000 State Farm at CityLine PO Box 653925 Richardson, TX 75085-3925 CPO State Farm® • State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 90 N MOUNTAIN AVE 474 '147• ASHLAND OR 97520-2014 S . o _ Inland Marine AttachingDeclarations Policy number: 97-CP-D437-8 ' '' Effective date;August 12, 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 MortgageelLienholderwritten 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 Pagel of 2 Prepared:August 19,2021 ©,Copyright,State Farm Mutual Automobile Insurance Company,2008, CIM Att Deo 3P OR.1 1009481 2002 153089 202 03-06-2021 FD-6007 ' 002640 O d Stat Frn r Endorsement , Coverage Limit of insurance Deductible amount .Annual premium number { FE-8754 Inland Marine Dealers-Service Form $500 t. . $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. , '•� 5 a , • • • Policy Number:97-CP-D437-8 Page 2 of 2 Prepared:August 19,2021 ©Copyright,State:Farm Mutual Automobile Insurance Company,2008 FD-6007 '