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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald E DBA Fashion Floors (2) State Farm at CityLine LI PO Box 853925 Richardson, TX 75085 3925 QState arm® AT1 000266 1200 01 State Farm Fire and Casualty Company x:, CITY OF ASHLAND A stock company with home offices'in;Biobmingtbn, Illinois 90 N MOUNTAIN.AVE •• ASHLAND OR 97520-2014 • • $1-i I1IIII'IIIIIIIIIIII'I'IlllIIIllll'lIiIiu!jIliiiiIiullIliiIl'lllll we Amended Declarations - -. „. . ...,.• . ._. , .. .•. . . • , .. .. . . . - • *,'• .;4r :. `:•+'p•;('/ !'1.',� ".:i1.>:Policy number: 97-CP-D437-8 Effective date: Novemer 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, 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 complianto-with the-policy provisions-or as-requifed by law: .-. r =- NAMED INSURED STRAW, DONALD E DBA FASHION FLOORS'.,'". ‘21•' ..• •".'.1. ,.'. r„ ' .... . ,:Y,'. ' c,4. ,.':.i'Ji-:' - . , ENTITY ' , . , Sole Proprietorship-Individual . , - . • REASONS FOR DECLARATIONS . Your policy is amended effective•November 12,2021 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.if an amount is due, then a separate statement will be sent prior to the due date. The prernium(s)shown below are for the policy period and policy characteristics as described in this Declarations. Decrease in premium: ($2.00) , Discounts applied: Business Experience Rating •Renewal Discount , Device Protectives . Years in Business , Policy Number:97-CP-D437-8 Page 1 of 6 Prepared:November 19,2021 ©.Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP Dec 3P OR.1 • 1009482 2005 153090 205 08-21.2021 CMP-4000 • 001041 • a'State Farmo • • 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 Business Personal Property •' :, • 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: 1.90.2. ,. • 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. 3:,:r•.,,;.;r,�; 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 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 Policy Number:97-CP-D437-8 Page 2 of 6 Prepared:November 19,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 - .. StateFarme Coverage Limit of Insurance ' t -Glass Expenses • ' V V - - . 'V... ' • ' "- - 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 See 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 V Outdoor Property .. See Schedule , V V - 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. $10,06-, - , Preservation of Property30 days . Property of Others(applies only to those premised:provided Coverage B-Business Personal Property) See Schedule Signs • v See Schedule ' Valuable Papers and RecordsSee V Schedule • Water Damage, Other Liquids,Powder or Molten Material Damagevv_v � ' Included SECTION I-EXTENSIONS OF COVERAGE-LIMIT.OF INSURi4NCE-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 Br Drain ,. . $15,000 • ' Money and Securities ' On Premises Limit • • ' $10,000,. ., ' Off Premises Limit $5,000 '. ._ V . . . . ' Outdoor Property • $5,000 V ' 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 V Page 3 of 6 Prepared:November 19,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 V 001042 O Q•StateFarme Location Coverage Limit of Insurance number _... .. .._. _ __ , . . .. . . . . . . . .-_ . .. . . Valuable Papers and Records' _ .. - • . -. ' On Premises Limit $10,000 • Off Premises Limit $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 . $5,000, Valuable Papers and Records On Premises Limit _ $10,000 Off Premises'Limit $5,000 . SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-.PER POLICY„ ,,,. ;., : _,, , :;,;-;..,, ., :;,,: :lo • ,. 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 . ' . 001 427 N RIVERSIDE AV . MEDFORD OR 97501:4602 . 003 516SFIR ST • MEDFORD OR 97501-3616 0 Policy Number:97-CP-D437-8 Page 4 of 6 Prepared:November 19,2021' ©Copyright,State Farm Mutual Automobile Insurance Company,2008 .,. CMP-4000 ' 00 u oa StateFarm® • SECTION II-DEDUCTIBLES • • Property Damage: • $250 &•• Other deductibles may apply-refer to policy. • • , SECTION II-LIABILITY • s§ Coverage Limit of Insurance ? .. .: �' ': ;.:=t.‘; $ Coverage L-Business Liability Per Occurrence`.• $1,000,000 • we 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 ahnual 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:November 19,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 • 001043 o StateFarm® FULL NAMED INSURED Named Insured: STRAW, DONALD E DBA FASHION FLOORS This policy is issued by the State Farm Fire and Casualty Company. ;i, s • '::.:> 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. • President - • :Secretary { .: • ,..t. e• ' • • • • Policy Number:97-CP-D437-8 - Page 6 of 6 Prepared:November 19,2021 ©Copyright,.State Farm Mutual Automobile Insurance Company,2008 • . CMP-4000 • state Farm at CityLine PO Box 853925 Y Richardson,,TX 76085-3925 CPO StateFarm State Farm Fire and Casualty Company :, ` CITY OF ASHLANDI. A stock company with home offices in Bloomington,-Illinois . r - 90 N MOUNTAIN AVE -• - -- `i• ASHLAND OR 97520-2014 . . . . 0 0 . .. -. • - . Inland Marine Attaching Declarations Policy number: 97-CP-D437-8 • Effective date;'November 12; 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 Farrri®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:November 19,2021. ©Copyright,State Farm Mutual Automobile Insurance Company,2008 . .• CIM Att Dec 3P OR.1 1009481 2002 153089 202 03-06.2021 FD-6007 001044 . • '0°6 StateFrm 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.. :'f,-.:i..?C• .Iii `I ~. • Policy Number:97-CP-D437-8 •Page 2 of 2 Prepared:November 19,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 . FD-6007 • • •