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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald E. DBA Fashion Floors (3) State Farm at CityLine `-' PO Box 853925 Richardson; TX 75085-3925 0°0 State Farm All 000372 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND A stock company/With hdrhe=offiaes`iii Bloomirigtori;illiriois rr� 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 S ,$ I'iIIIIIIrllrrllllirliiiiiiiII�Iniiiiii IIIIJlll"IIIIIIIIIIIII� , Amended DecIaration . . . .. , ,,..,,,.. ,1 , _ ;,,,,;.. 1._,_. . Policy number: 97-CP-D437-8 Effective date: September:28;, , 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, thispolicy 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. •., NAMED INSURED ' STRAW, DONALD EDBA•FASHION FLOORS":','i .:l.,:.-.,k,..,.., .'i_. " ,a: _;,, t:_ .y. ,.:•. .';-•:`."' T• '.1• ENTITY , ., Sole Proprietorship-Individual • . . REASONS FOR D DLARATIONS. - , ' . Your policy is amended effective September 28, 2021 due to some recent policy changes you requested. Enclosed•is a copy'of your new endorsements, if any. POLICY PREMIUM This is not a bill.!f an amount is due, then a separate statement will be sent prior to the due date. The a premium(s)shown below are for the policy• period and policy characteristics as described in this Declarations, .. Increase in premium:$13:00 , - ' ,• , Discounts applied: " ' . , Business Experience Rating Renewal Discount Protective Devices Years in Business Policy Number:97-CP-D437-8 Page 1:of 6 Prepared:September 28,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 ' CMP Dec 3P CR.1 1009462 2005 153080 205 08.21-2021 CMP-4000 001469 090 StateFarm SECTION,I'-PROPERTY SCHEDULE-:BLANKET, . - : Limit of insurance* Coverage A-Buildings: $961,200 Coverage B-.Business Personal Property: " $432,800 Location Location of described premises Seasonal increase- number BusinessPersonal Property 'i • ; ; , 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: , • $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. Coverage Limit of Insurance • Accounts Receivable See Schedule Arson Reward $5,000 , Back-up of Sewer or Drain , , See Schedule , , Collapse ' Included " •• 0 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 0 " Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration $10,000 Policy Number:97-CP-1)437-8 ' . Page 2 o 6 Prepared:September 28,2021 ,©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 u . •: ooStateFarmo • Coverage " , Limit of Insurance • 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 - - - o Money and SecuritiesSee Schedule 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 . . 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 Property 30 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 ' - " ' 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 28,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 'CMP-4000 001470 Q0 State Farm® Location Coverage Limit of Insurance • --number- .. . .. . . . _ . _Valuable.Papers and Records . . .' : '. ' . .' . On Premises Limit '• - $10,000 Off Premises Limit s $5,000 • 003 • 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 $5000 ' Valuable Papers and Records• On Premises Limit '• ' $10,000 . • Off Premises Limit $5• ,000 ., '. 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 • ' 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 •V ' 001 • 427 N RIVERSIDE AV • , • MEDFORD OR 97501-4602 • 003 _ 516 S FIRST MEDFORD OR 97501-3616 Policy Number:97-CP-D437-8. . Page 4 of 6 Prepared:September 28,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 V • CMP-4000 • u 09(:),StateFarin® SECTION II-DEDUCTIBLES ElProperty Damage: $250 t, , Other deductibles may apply-refer to policy. SECTION II-LIABILITY § Coverage Limit of Insurance :':L;' 'i-{di ; i;:};.:..'•• N Coverage L-Business Liability Per Occurrence . $1,001'),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 28,2021 '©Copyright;State Farm Mutual Automobile Insurance Company,2008 CMP-4000 001471 „ 0 State.Farm@ ; p . FULL NAMED INSURED Named Insured: STRAW, DONALD E DBA FASHION FLOORS 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 signedby its.President and Secretary at Bloomington, Illinois. President _ : Secretary • Policy Number:97-CP-b437-8 Page 6 of 6 Prepared:September 28,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 ' State Farm at CityLine u PO Box 853925 Richardson, TX 75085-3925 CFO StateFarme • State Farm Fire and Casualty Company CITY OF ASHLANDA stock company with home offices in Bloomington, Illinois • ka90,N MOUNTAIN AVE - : - - , - . - . . . ASHLAND OR 97520-20.14 ., g . • . 0 0 ;0 •_ • Inland Marine Attaching Declarations Policy number: 97-CP-D437-8 , • Effective date:.September 28, 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 $25,000 $500 Included Loss of Income and Extra Expense' $25,000 Included Policy Number:97-CP-D437-8 Page 1 of 2 Prepared:September 28,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 . • CIM Att Dec 3P OR.1 1009481 2002 153089 202 03-06-2021 FD-6007 001472 . • Q 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. 't • 3 ,t1' • • • is• • , ., • • • • • • Policy Number:97-CP-0437-8 • • Page 2 of 2 Prepared:September 28,2021 ©Copyright,,State Farm Mutual Automobile,Insurance Company,-2008 FD-6007