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HomeMy WebLinkAboutInsurance Certificate: Better View LLC state rarm at uryune PO Box 853925 Richardson, TX 75085-3925 CFO State Farme AT1 000748 1200 01 State Farm Fire and Casualty Company _,. CITY OF ASHLAND A stock company with home,offices-in•Bloomington; Illinois 20EMAIN ST . ASHLAND OR 975204814 g ... -. - . . . .. . . . _. . 0 $ 111111IIIIII1111111nlili1IIIIIIIlrliilirilr1rllnll111111111111l . . . . , no Declarations . , , . . .. ,. . . ,s .: . .,...... . „ .-. ,... . Policy number: 97-CW-A392-6 Effective date: September 3, 2021 ' ' Policy period: 12 months Expiration date: September 3, 2022, . . 7 , - The policy period begins and ends at 12:01 am standard time at the premises location, , BUSI NESSOWNERS POLICY Automatic renewal -If the State Farm°policy period is'shown as 12 months,`this policy will be renewed'autormatically 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: =, -- ' - — - - NAMED INSURED SHEA CATHEY •- ENTITY Sole Proprietorship-Individual . 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 premiums)shown below is the 12 months. ' premium(s)for the characteristics of the policy as.described`in this Declarations. , Total Premium: $325.00 . ' . . Minimum Premium Discounts applied: • . Business Experience Rating Business in Residence Premises Policy Number:97-CW-A392-6 , . Page 1 of 4 Prepared:September 2,2021 ©Copyright,State Farm Mutuel Automobile Insurance Company,2008 CMP Dec 3P OR.1 1009482 2005 153090 205 08-21.2021 CMP-4000 002936 0o Stat tin® SECTION -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 001 826 B.St No Coverage $10,000 •;° , '25%, ., • • , Ashland OR 97520-2030 *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 • $1,000 . , . . SPECIAL DEDUCTIBLES ' ' , . '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 correspondinglimits 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 On Premises $10,000 , , Off Premises $5,000 Arson Reward • .. • . , ; $5,000 , 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 Glass Expenses Included Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a 10% replacement cost basis) Policy Number:97-CW-A392-6 Page 2 of 4 Prepared:September 2,2021 ©Copyright,State Farm Mutual Automobile Insurance.Company,2008 CMP-4000 • U Q StateFarm® Coverage - Limit of Insurance NV . Money Orders and,Counterfeit Money, $1,000 , Money and Securities . . , On Premises $5,000 g • 4C Off Premises WO 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 . . - . , . ' • v - $5;000.'- . ' , Personal Effects(applies only to those premises provided Coverage B-Business Personal Property)' ' $2,500 ' Personal Property Off Premises $15,000 V 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)..,,,$2,500 ;,, ,. , Signs v. $2,500.-,: - 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 willpay regardless of the number of described premises shown in these Declarations. . , Coverage, Limit of Insurance Loss of Income and Extra Expense ,12 Months Actual Loss Sustained SECTION II-LOCATION SCHEDULE ' , - ' , ' , , Location Location of described premises - number , , 001 826 B St ' Ashland OR 97520-2030 ` ' • • ' SECTION II-LIABILITY • , ' . - Coverage. . . : Limit of Insurance Coverage L-Business Liability Per Occurrence $1,000,000 Policy Number:97-CW-A392-6 Page 3 of,4 Prepared:September 2,2021 ©.Copyright,State Farm Mutual Automobile Insurance Company,2008, . , - CMP-4000 002937 • 090 StateFarm® Coverage • Limit of Insurance . • Coverage M-Medical Expenses $5,000 Any One Person . Damage to Premises Rented to You $300,000 . 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-4543 Additional Insured-Designated Person or Organization • • CMP-4561.1 Policy Endorsement - CMP-4705.2 Loss of Income and Extra Expense S '' , - ' . CMP-4709 ._-Money and Securities ' • 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: Designated Person or Organization . Endorsement number: CMP-4543 Loan number:.. .. NIA . . . ... CITY OF ASHLAND • _ , .t 1! .i,. 20 E Main St .v',.'51, ,• Ashland,OR 97520-1814 -This policy is issued by the State Farm Fire and Casualty Company. PARTICIPATING POLICY • • - - • s. - 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. ' /vr€L4 • President Secretary • • Policy Number:97-CW-A392-6 ' Page 4 Of 4 Prepared:September 2,2021 ©Copyright,State Farm Mutual Automobile Insurance Company;2008 S GMP-4000 • State Farm at CityLine PO Box 853925 • ® • Richardson, TX 75085-3925 0 State Farm' State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 20EMAIN ST 3• ASHLAND OR 97520-1814 • a • 0 Inland Marine Attaching Declarations Policy number: 97-CW-A392-6 • Effective date: September 3, 2021 Policy period: 12 months Expiration date:'September 3, 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 Farms 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: Included The above premium amount is included in the Policy Premium shown on the Declarations. 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 Other limits and exclusions may apply-refer to your policy. • Policy Number:97-CW-A392-6 . Page 1 of 1 Prepared:•September 2,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • • CIM Att Dec 3P OR.1 • 1009481 2002 153059 202 03-06-2021 FD-6007 002938 u • • • CMP-4543 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. r4- . :;°` ADDITIONAL INSURED—DESIGNATED.PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: • • § BUSINESSOWNERS COVERAGE FORM • ' • SCHEDULE • Policy Number: 97-CW-A392-6 • Named Insured: SHEA CATHEY . • 20EMainSt Ashland OR 97520-1814 • Name And Address Of Additional Insured Person Or Organization: • CITY OF ASHLAND • 20EMain St . • Ashland OR 97520-1814 • • 1. SECTION II —WHO IS AN INSURED of SECTION II -,LIABILITY is amended to include, as an additional insured, any person ororganization shown in'the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal 'and advertising injury" caused, in whole or in part, by: .. a. Premises And Ongoing Operations Your acts or omissions or the acts or omissions of those acting on your behalf: (1) In connectionwithyour premises; or . (2) In the performance of your ongoing operations; or b. Products-Completed Operations "Your work" performed for that additional insured and included in the"produbts-completed operations hazard". 2. Any insurance provided to the additional insured shall only apply with respect td a claim made or a"suit" brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insurance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. All otherpolicy provisions apply. • • • CMP-4543 . 154981 04-17-2018 • ©, Copyright, State Farm Mutual Automobile Insurance Company, 2018 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 002939