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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald E. DBA Fashion Floors • State Farm at CityLine U PO Box 853925 ' Richardson, TX 75085-3925 090 StateFarms AT1 000365 1200 01 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 ' s �o 'lllll'IIIIIIIIIIIII111111IIIIII'I'll"IulII"IIIII'IIIIIII111111 • : Amended. Declarations • : Policy number: 97-CP-D437-8. Effective date:"August 23,'2021' F.` 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 succeeding.policy period,.If this policy isterminated,: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 FLOORS +', , ENTITY Sole Proprietorship=Individual • REASONS FOR DECLARATIONS Your policy is amended effective August 23,2021 due to•some recent policychanges 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"are for the policy period and policy characteristics as described in this Declarations. ' ' ' Increase in premium: $4.00- • Discounts applied: • ' Business Experience Rating Renewal Discount Protective Devices ' Years in Business • Policy Number:97-CP-D437-8 Page 1 of 6 Prepared:August 23,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP Dec 3P OR.1 1009482'2005 153090 205 08-21-2021 CMP-4000 001417 .• StateFarm® 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) . . . k , Coy A-Inflation Coverage Index: 190.2 . , .. Coy B-Consumer Price Index: 260.4 . _ . SECTION I—DEDUCTIBLES. •BASIC DEDUCTIBLE $1,000 r :.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 ReceivableSee 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 '0 - $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 23,2021 ©'Copyright,State Farm Mutual Automobile Insurance Company,2008 GMP-4000 : u . cac StateFarm® Coverage Limit of Insurance " klGlass Expenses - • - - - - • Included - 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 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 ti . • 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-'SCIIEDULE - '' • ': `':'-. " ' -% ' ' - . - ' - - • The-coverages'and-corresponding limits shown below apply,onIV•to the;described premises:as showh. - ' 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 - ' 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 23,2021 ©Copyright,State Farm Mutual.Automobile Insurance Company,2008 . , • CMP-0000 001418 . , Stat F arm° • Location Coverage ,,, ' Limit of Insurance • number Valuable•Papers and Records . - • • - , On Premises Limit $10,boo • ; • u 090 StateFarme SECTION II-DEDUCTIBLES Property Damage: $250 '•• •'•Other deductibles may apply-refer to policy. • SECTION II-LIABILITY § Coverage , Limit of Insurance r'i o • �$ 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-4745:1 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 23,2021 ©Copyright,State.Farm Mutual•Automobile Insurance Company,2008 CMP-400D . nn141Q • o&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. , President • Secretary- _ " , ` . I. • e- . i .. ':'• .' til'• 1 • • • Policy Number:97-CP-D437-8 Page 6 of 6 Prepared:August 23,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 GMP-4000 State Farm at CityLine u Ric Box 853925 - 090 State Farm®Richardson,. TX 7585-3925 • State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois: 90 N MOUNTAIN AVE --.- •- • . . .• • . . - ,... . .. . Em ASHLAND OR 97520-2014 . . 8 �� . . Inland Marine AttachingDeclarations - . , . Policy number: 97-CP-D437-8. Effective date: August 23,2021 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 MortgageelLienholder 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-0437-8 , Page 1 of 2 Prepared:August 23,202.1 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 , • . • CIM Att Dec 3P OR.1 1009481 2002 153089 202 03-06-2021 FD-6007 . • • 001420, o o Stat rm® . 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.. ,. tz • Policy Number:97-CP-D437-8 ' ' ' Page 2 of 2 Prepared:August 23;2021 ©Copyright;State Farm Mutual Automobile'Insurance Company,2008 FD-6007 '