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HomeMy WebLinkAboutInsurance Certificate: Jeremy Maneker State Farm at CityLine U PO Box 853925 , Richardson,,TX 75085-3925 d StateFar e AT2 000596 1200 01 .. State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home-offices in'Bloomington; Illinois EA?' 20EMAIN ST ASHLAND OR 97520-1814 O 111II1111111"11111111111I 1111111111111111l1Il"11"II"11111 i;1 o • Renewal Declarations. - • :2,k.,-37 lb.' • - e- Policy number: 97-CR-B526-0. • Effective date: September 9, 2021 Policy period: 12 months Expiration date: September 9, 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, isterminated,-we-will give you and the _ MortgageelLienholder written notice in compliance with`th'e policyprovisiens oras required-by-law: = " NAMED INSURED JEREMY MANEKER 479 Marion Ln Grants Pass OR 97527-5570 • ENTITY Sole Proprietorship-Individual IMPORTANT MESSAGE(S) Notice Information concerning changes in your policy language is included,Please call your agent if you have any questions.'" 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 months' premium(s)for the characteristics of the policy as described in this Declarations: Total Premium: $2,401.00 Discounts applied: - Business Experience Rating f,,. Protective Devices Years in Business , Policy Number:97-CR-B526-0 Page 1 of 5 Prepared:July 2,2021 ©Copyright,State Farm Mutual AutomobileInsurance Company,2008 CMP Dec 3P OR.1 1009482 2003 153090 203 04.10.2021 CMP-4000 ' 002357 090 StateFarm® 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 001 2001 NE Foothill Blvd Ste E4 No Coverage $206,200 • , 25%, • Grants Pass OR 97526-4240 *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: 267.1 SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE' ';$1,000. SPECIAL DEDUCTIBLES: Employee Dishonesty: $250 Equipment Breakdown: $1,000 Garagekeepers-Collision: $500 Garagekeepers-Comprehensive: $250 Money and Securities: $250 ' Other deductiblesmay 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 • 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 0 , Per Occurrence $2,500 Equipment Breakdown Included Policy Number:97-CR-B526-0 0 Page 2 of 5 Prepared:July 2,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 . CMP-4000 u c o StateFarm® Coverage Limit of Insurance ' i "•' Fire Department Service Charge Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration $10,000 NGaragekeepers Insurance-Direct Coverage $25,000 CO Glass Expenses Included,, Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a 10%. ' replacement cost basis) , r r 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 V Outdoor Property 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 $20,000 . Preservation of Property 30 days Property of Others(applies only to those premises provided Coverage B-Business Personal Property). $100,000 • Signs $5,000 Valuable Papers and Records On Premises •$10,000 • Off Premises - 1• $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 premise's shown in these Declarations. Coverage V . 'Limit of-Insurance , ,. • Employee Dishonesty • $10,000 Loss of Income and Extra Expense 12 Months'Actual Loss Sustained Policy Number:97-CR-B526-0 Page 3,of 5 Prepared:July 2,2021 ©•Copyright,State Farm.Mutual Automobile Insurance Company,2008 • CMP-4000 002358 690 StateFarm SECTION II-LOCATION SCHEDULE " Location Location of described premises number. . . 001- 2001 NE Foothill Blvd Ste E4 • - - Grants Pass OR 97526-4240 ' ' SECTION II-DEDUCTIBLES .. .. . , .. ._ Property Damage: $250 ' Other deductibles may apply-refer to policy. _ SECTION II-LIABILITY . ' . Coverage - Limit of Insurance Coverage L-Business•Liability Per Occurrence .$2,000,00 . Coverage M-Medical Expenses. , . $5,000 Any.One Person . Damage to Premises Rented to You _ •.. .. .$300,000 Garage Liability Included in Coverage L Operation of Customers'Auto on Particular Premises , Included , . , • Aggregate.LimitsLimit of Insurance Products/Completed Operations Aggregate.,. . . . _, . . $4,000,000 General Aggregate $4;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 andendorsements that apply,including those shown below as well as those issuedsubsequentto the.issuance of this policy. _ , , FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form CMP-4237.1 Amendatory Endorsement(Oregon) - CMP-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). ., , • , , CMP-4705.2. Loss of Income and Extra Expense - -- . ' ' ' . '. . - . - ... CMP-4706 Back-up of Sewer or Drain CMP-4709 Money and Securities ' ' :i '",:,, `'' "')it '' ;. - , - , . ' . . CMP-4710 . Employee Dishonesty , . CMP-4742.1 " Garage Liability ' CMP-4744 Garagekeeper's Insurance-Direct Coverage ' CMP-4827.1 . Employee Tool Coverage FD-6007 , Inland Marine'Attaching Declarations .. ' -. FE-3650 Actual Cash Value-Endorsement ' - . * FE-6999.3 Policyholder Disclosure Notice of Terrorism Insurance Coverage *New Form Attached , Policy Number.97-CR-8526-0 Page 4 of 5 Prepared:July 2,2021 . ©Copyright,State Farm Mutual Automobile Insurance Company;2008 GMP-4000 . u • 60 StateFarm® SCHEDULE OF ADDITIONAL INTEREST(S) Interest type: Designated Person or Organization . Endorsement number: CMP-4543 Loan number: N/A City of Ashland 20 E Main St g Ashland OR 97520-1814 `n FULL NAMED INSURED Named Insured: JEREMY MANEKER DBA WRAP IT UP GRAPHICS, CITY OF ASHLAND This policy is issued by the State Farm Fire and Casualty Company. • '. PARTICIPATING POLICY You are entitled to participate in a distribution of theearnings 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. 'Lem. President Secretary • NOTICE TO POLICYHOLDER: For a comprehensive description of coverage and forms, please refer to your policy. • Policy changes requested before the "Date Prepared",which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also'effective on the Renewal Date of this policy. ' Policy changes requested after the "Date Prepared"will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property,items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. • Please keep this'with your policy. Your coverage amount.... ' It is up to you to choose the coverage and limits that meet.your needs. We recommend that you purchase a coverage limit equal to the estimated replacement cost of your structure. Replacement cost estimates are available from building contractors and replacement cost appraisers, or, your agent can provide an estimate from Xactware, Inc. using information you provide about your structure. State Farm does not guarantee that any estimate will be the actual future cost to rebuild your structure. Higher limits are available at higher premiums. Lower limits are also available;•as long as the amount of coverage'meets our underwriting requirements. We encourage you to periodically review your coverages and limits.with your agent and to notify us of any changes or additions to your structure. • Policy Number:97-CR-B526-0 Page 5 of 5 Prepared:July 2,2021 ©Copyright,State.Farm Mutual Automobile Insurance Company,2008 CMP-4000 nroaRa State Farm at CityLine `J PO Box 853925. Richardson, TX 75085-3925 0°0 State Fanny State Farm Fire and Casualty,Company �,,, CITY OF ASHLAND A'stook company with home offices in Bloomington, Illinois 0 20EMAIN ST ASHLAND OR 97520-1814 0 o • in0 • Inland Marine Attaching Declarations' Policy number:97-CR-B526-0 'Effective date: September 9, 2021 Policy period: 12 months Expiration date:September 9, 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 oras required by law. Annual policy premium: Included The above premium amount is included in the Policy Premium shown on the Declarations, FULL NAMED INSURED Named Insured: JEREMY MANEKER DBA WRAP IT UP GRAPHICS, CITY OF ASHLAND 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-CR-B526-0 • . Page 1 of 2 Prepared:July 2,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR.1 1009461 2002 153089 202 03-06-2021 FD-6007 002360 • orStateFarrn Other limits and exclusions may apply'="refer to your policy. • I., Policy Number:97-CR-B526-0 Page 2 of 2 Prepared:July 2,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Li CMP-4543 Page 1 of THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 1 L M. ADDITIONAL INSURED—DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following; BUSINESSOWNERS COVERAGE FORM CO 0 SCHEDULE Policy Number: 97-CR-B526-0 Named Insured: JEREMY MANEKER DBA WRAP IT UP GRAPHICS 20EMain St Ashland OR 97520-1814 '. Name And Address Of Additional Insured Person Or Organization: City of Ashland the City of Ashland, Oregon, its officers, agents,'and employees 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"products-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. M901R1. .. .: