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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, DOnald E. DBA Fashion FLoors (2) State Farm at CityLine PO Box 853925 Richardson, TX 75085.3925 090 Q tate Carp„® AT1 000445 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington,.Illinois=. pAt90 N MOUNTAIN AVE ASHLAND OR 97520-2014 S uIIIlilililiIIIilllliIili1illiiii1IriiIIliIiliilIIIilillrfiiIllll nG • • Amended . Declarations . • • ' • Policy number: 97-CP-D437-8 Effective'date:S'eptemb'er 29;'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 • MortgageelLienholder written notice in cornpliance with the policy provisions oras required by law: NAMED INSURED STRAW, DONALD E DBA FASHION FLOORS ; -• ' , ,-; „ I ..- . ' ENTITY . • Sole Proprietorship-Individual • REASONS'FOR DECLARATIONS Your policy is amended effective September 29,2021 due to some recent policy changes you requested, Enclosed is a copyof 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. Change in premium: none. Discounts applied: ' Business Experience Rating Renewal Discount Protective Devices ' Years in Business Policy Number:97-CP-D437-8 • Page 1 of 6 Prepared:September 29,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008. CMP Dec 3P OR.1 1009482 2005 153090 205 08-21.2021 CMP-4000 001748 oa.StateF rm® SECTION I PROPERTY SCHEDULE—BLANKET ' ' Limit of insurance* J , 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,: ri •, • $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. IA',..i• a.i. r• Coverage . Limit of Insurance . Accounts Receivable See Schedule . Arson Reward $5,000 ,;.f:'. ;.i ; i 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:September 29,2021 0 Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 ' • u • 00 StateFarme Coverage • .. , Limit of Insurance . .. , 1•• L '174•` 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 • $ n money and Securities See Schedule • , • Newly Acquired Business Personal Property(applies only if this policy provides Coverage B-Business $100,000 , Personal Property) - - - 1 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 ' ,I: -. -?" ''' e: 94. • 11•— The coverages and corresponding limits shown below: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 29,2021 •©Copyright,State..Farm Mutual Automobile Insurance Compahy,2008 • CMP-4000 001749 . . , ,. . Q 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 ,. . , - . • • . " r -,$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 . r Personal Property) . • Signs $5,000; Valuable Papers and Records;; , . On Premises Limit, - I. $10,000 . Off Premises Limit • , , • $5,000: , . , , • , SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE;-PER;POLICY,• ,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 _. I. _ 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 975014602 . . , 003 516 S FIRST .. - - . _. MEDFORD OR 97501-3616 ' ' Policy Number:97-CP-D437-8 Page 4 of 6 Prepared:September 29,2021 ©Copyright,'State Farm Mutual Automobile Insurance Company,2008 ' cmP.400n c_;-'0 State Farm® SECTION II-DEDUCTIBLES Property Damage: $250 ' Other deductibles may apply-refer to policy. SECTION II-LIABILITY gCoverage Limit of Insurance $ Coverage L-Business Liability Per Occurrence $1,000,000 Coverage M;Medical Expenses . -$10,000 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: N/A CITY OF ASHLAND • 90 N Mountain Ave - Ashland OR 97520-2014 • Policy Number:97-CP-D437-8 Page 5 of 6 Prepared:September 29,2021 ©Copyright,State Farm Mutual Automobile,lnsurance Company,2008 ' CMP-4000 • • 001750 o Stateirn® s. FULL NAMED INSURED Named Insured: STRAW, DONALD E DBA FASHION FLOORS .: This policy is issued by the State Farm Fire and Casualty Company. 'j . • •. 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 . • • . • -1r „ fft •, r1 • 1 Policy Number:97-CP-D437-8 Page 6 of 6 Prepared:September 29,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 . CMP-4000 Li State Farm at CityLine ' PO Box 853925 . Richardson, TX 75085-3925 ©StateFarm' State Farm Fire and Casualty,Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois ,i . .90 N MOUNTAIN AVE : . _ ._ _ _y::1+• ASHLAND.OR 97520-2014 S . . , 0 .63 . Inland Marine Attaching Declarations '' ' ' • . . , Policy number: 97-CP-D437-8 Effective date: September 29, 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 $25,00Q $500 Included Loss of Income and Extra Expense $25,000 Included • Policy Number:97-CP-D437-8 . • Page 1 of 2, Prepared:September 29,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008: CIM Att Dec 3P OR.1 1009481 2002 153089 202 03-06-2021 FD-6007 . . 001751 , 0o StateFarm® 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. • • • • • • Policy Number:97-CP-D437-8 Page 2 of,2 Prepared:September 29,2021 ©`Copyright,State Faith Mutual Automobile Insurance Company,2008 FD-6007