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HomeMy WebLinkAboutAmended Insurance Certificate: Straw,Donald E. DBA Fashion Floors oLaLC rcnm aC L ILLme - PO Box 853925 Richardson,,TX 75085-3925 CFO State Farm' AT1 000519 1200 01 State Farm Fire and Casualty Company ., CITY OF ASHLAND A stock company,with•hdrtieoffices'in:Bloomingtoh;-:Illinois -ti 90 N MOUNTAIN AVE ASHLAND OR 97520-2014" . O IL.. � � I � I I �Irllll �� LI �� III �� I II. � : . g I I I l I l I II I Ililil I I it I 11 ILII III , (75o Amended Declarations -.. - .. • , •..,. , ,,. ..v..,,„ , -,,..„ ! .;,-., , . .„. . ' Policy number: 97-CP-D437-8 ' Effective date:-August 26,. . "'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 succeeding policy period. If this policy is,terminated, we will give you and the Mortgagee7Lierihold6rwritten notice in compliance with the polidy provisions or as required by law.__ , . . NAMED INSURED STRAW, DONALD E DBA FASHION FLOORS ',,J- ..... ;ii . .. t%I.: 'as, -:t: l''^i ): ; _ • . ?° ENTITY . Sole Proprietorship-Individual , • REASONS FOR DECLARATIONS Your policy is amended effective August 26, 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 be_lo_w are for the_ polic ' y period and policy characteristics as described in this Declarations. S Increase in premium: $11.00 •Discounts applied: ' Business Experience Rating Renewal Discount • ' Protective Devices Years in Business • Policy Number:97-CP-D437-8Page 1 of 6 Prepared:September 23,2021 • ©Copyright,State"Farm Mutual Automobile Insurance Company,2008 , CMP Dec 3P OR.1 1009482 2005 153090 205 08-21-2021 CMP-4000 002064 • Qo Statear►n® 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: . _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: Other deductibles may apply-referto 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. t„ . . . . 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-D437-6 Page 2 of 6 Prepared:September 23,2021 ©Copyright,State Farm Mutual Automobile.Insurance Company,2008 CMP-4000 • u . 090 State Farme Coverage Limit of Insurance 217". Glass Expenses -.•" - - .. - • " - Included • - }ii• . ., 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 . . , 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 b'elow'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 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:September 23,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 mmrias • • , 090 StateFarme . , • 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 . • ' - ' - - _ f ', . $10,000. ' . - . • . . . 'Off Premises Limit ' • _ .'. . . .$5,00P . . , Back-up of Sewer or Drain • ' ' $15,000 . ' _ • . Money and Securities . , .. .0n Premises Limit ' $10,000 Off Premises Limit ' . ' . • $5,006 - ) ' - _. . • 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 Recor0. — • . On Premises Limit : $10,000 . , . . . • . _ _ ._. ,. . Off Premises Limit $5 000 .. . _ , . . ,..... . ., . . . . ... . , . ... .. _ SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER P,OLICYn,,,„.., ..-,,.- ,-.• ..‘.•.. ..-- ;, . . . The coverages and corresponding limits shown below are the most we will pay regardless of the,numberof described premises shown in these Declarations. ,. •'• ... . Coverage . Limitof Insurancef . . . . . . . - . . . . , Dependent Property-Loss of Income $5,000 • 2 ' Employee Dishonesty 2.- ' • • • ,. $10,000. •',.:----- -• . , Loss of Income and Extra Expense , 12 Months AotUal LOsstustained . . . . . . . , Utility Interruption-Loss of Income $10,000 .• • . . SECTION II-LOCATION SCHEDULE. . . . • .. . • Location •. Location of describedpremises ,'• . , . . -- • - " . number • • , • • . . 001 427 N RIVERSIDE AV ,, .. - MEDFORD OR'975014602 _ ' - - .. ' - -• . . , , • • • 003 516 S FIR ST . • • , . . . . . • MEDFORD OR 97501-3616 , , . • . • Policy Number:97-CP-D437-8 ‘ : Page 4 of 6 Prepared:September 23,2021 ©Copyright,State Farm Mutual Automobile Insurance Company;2008 CMP-4000 • • co State Farm® SECTION II-DEDUCTIBLES . - Property Damage: $250 ._, .Other deductibles may apply-refer to policy. SECTION II-LIABILITY ' . : ' . •§ Coverage . Limit of Insurance . '.).•..: ":': ^.i. CoverageL-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 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 '. . • t' Page'5 of 6 Prepared:September 23,2021 .©Copyright,,State.Farm'Mutual Automobile Insurance Company,2008 ' .. . ' • CMP-4000 002066 090 StateFarm® 4 r,. 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-lncorporation, 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. WieZeia,sg rn. President. . . .. Secretary. _ . • . • • • f S Policy Number:97-CP-D437-8 0 Page 6 of 6 Prepared:September 23,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 State Farm at CityLine u PO Box 853925 Richardson; TX 75085-3925 , Q 0 State Farm' State Farm Fire and Casualty Company CITY OF ASHLAND • . ..,. -' A stock company with home offices in Bloomington, Illinois .-.. 90.N MOUNTAIN AVE - . _ ... ... . . ... ... . .. t- ASHLAND OR 97520-2014- S O Cl) • • Inland Marine Attaching Dcclaratiohs •• .' Policy number: 97-CP-D437-8 Effective date: August 26, 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 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:September 23,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR.1 1009481 2002 153069 202 03.06.2021 FD-6007 ' 002067 • • • . •0'StateFarm® Endorsement. ' Coverage Limit of insurance Deductible amount Annual premium number •i: ' ' , . 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. . • • • ,f' ,,., a p,: ',I .i.„,,,,': i VP • • • Policy Number:97-CP-D437-8 •- Page 2 of 2 Prepared:September 23,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 ' '