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HomeMy WebLinkAboutInsurance Certificate: Shea Cathey Mate rarm at t:nyune PO Box 853925 . - Richardson, TX 75085-39250 State Farme AT1 000748 1200 01 . . .State Farm Fire and Casualty Company. .. CITY OF ASHLAND A stock company with home.offices irr Bloomington Illinois . 20EMAIN ST ASHLAND OR 97520-1814 8 . _. . . .._ . ._.. .. . . 0 I1II1IIII1I111111l1rtlrliIllllIIIlrllrllrllhIrllnlllhIIlI1lrllll ' ns 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. • • • , BUSINESSOWNERS POLICY Automatic renewal -If the State Farm°'policy period'is`shovun as 12 months,'this policy will be renewed'automatically subject to'the premiums, rules and forms in effect for each succeeding policy period.'Ifthis policy is terminated,-we will give you and the - • -' MortgageelLienholder written-notice in compliance=with-the policy provisionsbras required bylaw: _, : - - ' -- - - - - - . NAMED INSURED SHEA CATHEY I : 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 premium(s)shown below is the.12 Month's- premium(s) onths premium(s)for the characteristics.of the policy as.described in this Declarations. Total Premium: $325.00 5 . Minimum Premium Discounts applied: Business Experience Rating S ' Business in Residence Premises ' Policy Number:97-CW-A392-6 . • . . Page,1 of 4 Prepared:September 2,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP Dec 3P OR.1 1009482 2005 153090 205 08-21-2021 CMP-4000 . 002936 ` '• f ,, : OCC)Stateint' 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 , $1,00.0.•• , , . . SPECIAL DEDUCTIBLES:- ' v ' • •. . .• . . . 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 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 o StateFarrme Coverage Limit of Insurance aMoney Orders and.Counterfeit Money, ,. $1,000' Money and Securities - , , On Premises $5,000 § Off Premises . . .. . . Fo y 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• Personal Effects(applies only to those premises provided Coverage B Business'Personal Proper 'ty)"'' . $2,500 . Personal Property Off Premises $15,000 "' 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 $2,500. Valuable Papers and Records . On Premises 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 prerrlises 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 _ o StateFarmo Coverage Limit of Insurance • ,•• ' Coverage M-Medical Expenses t'. $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 I I 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 ' . ' " .. . 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 • 1. . CITY OF ASHLAND 20EMain St ,l , . . • `':,11_ .a:'^. .fi . „' - Ashland OR.97520-1814 n 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. . -'. •: .r t., . 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, zezeite.4)i.--- . ,rn President Secretary ' ' ;` ,. ; • • Policy Number:97-CW-A392-6 . Page 4 Of 4 Prepared:September 2,2021 ©Copyright,State Farni Mutual Automobile Insurance Company,2008 cMP-coo State Farm at CityLine • PO Box 853925 • Richardson, TX 75085-3925 • 0 StateFarm® • State Farm Fire and Casualty Company " CITY OF ASHLAND ' A stock company with home offices in Bloomington, Illinois 20EMAIN ST ' ei}'• ASHLAND OR 97520-1814 • • s -o • • 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 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: 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 153089 202 03-05-2021 FD-6007 " 002938 u CMP-4543 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. r;9. ADDITIONAL INSURED—DESIGNATED.PERSON OR ORGANIZATION This endorsement modifies insurance provided,under the following: g BUSINESSOWNERS COVERAGE FORM • g SCHEDULE • Policy Number: 97-CW-A392-6 • Named Insured: SHEA CATHEY 20 E Main St 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 or organization 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 connection with your 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 to 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 other.policy 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 .