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HomeMy WebLinkAboutAmended Insurance Certificate: Better View LLC State Farm at CityLine PO Box 853925 rRichardson, TX 75085-3925 GCQ State Farms AT1 000409 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND FLEET SERVICES A stock company with homeoffices in Bloomington,-Illinois •• 90 N MOUNTAIN AVE r#: ASHLAND OR 97520-2014 g - - . _ . 0 N • o IIIIIIIIIlIIIIIIIIIIIIIIIIIIu1Irl1II1IIIr1II1Il1111111111II111111 • , Amended Declarations V V ' . . Policy number: 97-AA-B135-1 Effective date: September 1, 2021 • ' Policy period: 12 months Expiration date: June 27, 2022 ` - • The policy period begins and ends at 12:01.•am standard time at the premises location, • AUTO SERVICES 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 Mortgagee/Lienholder written notice in compliance-With-the'policyprovision's oras.required-by law.` - • - - ' ' - - - • NAMED INSURED' ' . . BETTER VIEW LLC , ENTITY . Limited-Liability Company .. - V - ' - • ' - . V V REASONS FOR DECLARATIONS . Your policy is amended effective September 1, 2021 due to some recent policy changes you requested. Enclosed is a copy of your new endorsements, if any.• - POLICY PREMIUM V _ - - _ ._ 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. , Decrease in premium: ($1,425.00). ' Discounts applied: . Business Experience Rating V .. '.... Renewal Discount •. ' • Years in Business , . , Policy Number;97-AA-8135-1 Page 1 of 5 Prepared;September 24,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 , CMP Dec 3P OR.1 1009482 2005 153090 205 08-21-2021 CMP-4000 • 001600 • 00 Sta ar& SECTION I-PROPERTY SCHEDULE . Location Location of described premises Limit of Insurance* Limit of Insurance* Seasonal increase- ' number Coverage A- - Coverage B-Business Business Personal Property Building ,Personal Property 002 204 S Fir St No Coverage $78,000, ' 25% i Medford OR 97501-3118 *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) Cov A-Inflation Coverage Index: ' N/A • . • Coy B-Consumer Price Index: 273 ' • SECTION I-DEDUCTIBLES BASIC DEDUCTIBLE $500 .. SPECIAL DEDUCTIBLES: -' Employee Dishonesty: $250 . " Equipment Breakdown: $500 Garagekeepers-Collision: $500 Garagekeepers-Comprehensive: $250 3. • .',.,' ; ; 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"•iridicafed, refer to that policy-provision for an explanation of that coverage. Coverage. Limit of Insurance • • S Accounts Receivable On Premises • • $10,000 Off Premises $5,000 Arson Reward $5,000 Back-up of Sewer or Drain $15,000 Collapse • - • Included • Damage to Non-owned Buildings from Theft,Burglary or Robbery Coverage'B Limit . .. ' -. • Debris Removal . 25%of covered loss Employee Tools(applies only to those premises provided Coverage.B-Business Personal Property) • Per Employee $500 • . Per Occurrence $2,500 • Equipment Breakdown Included Policy Number:97-AA-8135-1 - Page 2 of 5 • Prepared:September 24,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 ' ' Li 0 State Farm® Coverage Limit of Insurance ' - '. • . . im. , , Fire Department Service Charge . $5,000' ' - • Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration $10,000 S Ft Garagekeepers Insurance-Direct Coverage $25,000 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 Money and Securities - - • - - -• . " _. On Premises .. . . • • - $10,000 Off Premises • - $5,000 - - 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 - ' . . . " $5,000 ' Personal Effects(applies only to those premises provided Coverage B-Business Personal Property) ' $2,500 ' Personal Property Off.Premises -- ' . • - "$15,000 - , .- Pollutant Clean Up and Removal • ' . ' $20000' ' Preservation of Property30 days Property of Others(applies only to those premises provided Coverage B .Business Personal.Property). ..:$2;500' . .. . Signs $5,000 . . ., ' -,- .,f3. ., 1E .) > `" Valuable Papers and Records ' , . On Premises • - • $10,000:• • • •• Off Premises • • . • ' •$5,000' ' Water Damage, Other Liquids,Powder or Molten Material Damage . • •- .Included • ' • SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY ' ' 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 . . Employee Dishonesty $10,000 .. Loss of Income and Extra Expense '12 Months'Actual Loss Sustained . Policy Number:97-AA-B135-1 'Page 3 of 5 Prepared:September 24,2021 ©Copyright,.5tate Farm Mutual•Automobile Insurance Company,;2008 , . CMP-4000 001601 oa StateFarm® SECTION II-LOCATION SCHEDULE. - . , . Location Location of described premises • number - • • 002 204 S Fir St - - • Medford OR 97501-3118 SECTION II-DEDUCTIBLES -. . Property Damage: $250 . Other deductibles may apply-refer to policy. . i . . . SECTION II-.LIABILITY . Coverage •- - - Limit of Insurance -- •- Coverage L—Business LiabilityPer Occurrence - • - $1,000,000.- , Coverage M Medical Expenses , $5,000-Any One Person Damage to Premises Rented to You • - - $500,000 • • Garage Liability Included in Coverage L Operation of Customers'Auto on Particular Premises .. Included• • '. _ ' 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 BUSINESSOWNERSCOVERAGE 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) . _ - . CMR-4412 Operation of Customers'Auto on Particular Premises • CMP-4527. Marijuana Exclusion - CMP-4543 Additional Insured-Designated Person or Organization • CMP-4561.1 Policy Endorsement - - - . • . CMP-4683.1 Additional Insured-Owners,Lessees or Contractors(Blanket) .. 1,. . ' CMP-4684.1 Additional Insured-Owners;Lessees or-Contractors(Scheduled) - - • • •- - - . •-- CMP-4705.2 Loss of Income and Extra Expense .... CMF 4706 '".:_ ,,; r=: :'• ,. t.. I - ^ - „r,:?• Back-up of Sewer or Drain CMP-4709. Money and Securities- , , . CMP-4710 Employee Dishonesty . CMP-4742.1 Garage Liability CMP-4744 Garagekeeper's Insurance-Direct Coverage CMP-4787 Waiver of Transfer of Rights of Recovery Against Others T_o Us CMP-4827.1 ' Employee Tool Coverage . PD-6007 Inland Marine Attaching Declarations • ' ., FE-3650 Actual Cash Value Endorsement - FE-6999.3 Policyholder Disclosure Notice of Terrorism Insurance Coverage Policy Number:97-AA-8135-1 • ' Page 4 of 5 Prepared:September 24,2021 . ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP.4000 • u 090 StateFarm SCHEDULE OF ADDITIONAL INTEREST(S) Interest type: Owners,Lessees, or Contractors(Schedul '7. Endorsement number: CMP-4684.1 - Loan number: N/A CITY OF ASHLAND FLEET SERVICES/FACILITIES MAINTENANCE 90 N Mountain Ave Ashland OR 97520-2014 "� FULL NAMED INSURED Named Insured: BETTER VIEW LLC DBA FARRELL'S GLASS SERVICE 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. .f President 0 Secretary Policy Number:97-AA-B135-1 Page 5 of 5 Prepared:September 24,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 001602 State Farm at CityLine PO Box•853925 Richardson, TX 75085-3925 090 StateFartne State Farm Fire and Casualty.Company CITY OF ASHLAND FLEET SERVICES A stock company with home offices in Bloomington, Illinois 90 N MOUNTAIN AVE i*# ASHLAND OR 97520-2014 • S O n$ Inland Marine Attaching Declarations Policy number: 97-AA-B135-1 Effective date: September 1, 2021 Policy period: 12 months Expiration date: June 27, 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 bylaw. • • Annual policy premium: Included The above premium amount is included in the Policy Premium shown on the Declarations. FULL NAMED INSURED Named Insured: BETTER VIEW LLC DBA FARRELL'S GLASS SERVICE 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 • 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-AA-B135-1 . , Page 1 of 2. Prepared:September 24,2021 ©,Copyright,State Farm Mutual,Autornobile Insurance Company,2008 , „ , CIM Att Dec 3P OR.1 1009481 2002 153089 202 03-06-2021 FD-6007 001603 090 StateFarm® Other limits and exclusion's may apply-refer to your policy. , Policy Number:97-AA-8135-1 Page 2 of 2 Prepared September 24,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007