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HomeMy WebLinkAboutAmended Insurance: Straw, Donald E DBA Fashion Fl State Farm at CityLine U PO Box 853925 • /�f Richardson, TX 75085-3925 6 StateFarme AT1 000262 1200 01 . State.Farm_Fire and,Casualty Company CITY OF ASHLAND A stock company with home offices in Blobmington;'lllinois WE 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 2014 • 8 r . 'III'IIIIII'Ill'IIIIIIIliiiIIIIIIIiiIIIiilJInlilll,Iiliiiiliriii • .. .. --• .. .. - Amended Declarations - [ , , ,,,:_!„.„ „ ):., -,.,.,:-..,: ,,,,.•,,i7, ,,„,,, ..••,,,..„,„:, . . . . • . . .. Policy number:97-OP-D437-8 Effective date:December 7, 2021 " Policy period: 12 months Expirationdate:February 18, 2022 ' The policy period begins and ends at 12:01 am standard time at the premises location. ;•s ,. 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 _' _ - MortgageeiLienholder Written-r otice•'in compliance with the policy provisions or as required"by law. "" NAMED INSURED STRAW, DONALD E DBA FASHION FL , ENTITY . .' Sole Proprietorship-Individual • REASONS FOR DECLARATIONS , ` ' ' " , Your policy is amended effective December 7, 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 premium(s)shown below are for the policy period and policy characteristics as described in this Declarations: Increase in premium: $4.00 . Discounts applied: • Business Experience Rating - - • Renewal Discount . Protective Devices, Years in Business . Policy number:97-CP-D437-8 Page 1 of 6 Prepared:December 15,2021 ©Copyright, State Farm Muttaal,Automobile..Insurance pompany,.•2006 , CMP Dec 3P ORA ' CMP-4000 - 1009482 2005 153090 205 08.21-2021 000993 . , . . . . . . ... . - ' oc2oStateFarm® . . _ . . . SECTION1-PROPERTY SCHEDULE- BLANKET . , ! _ , • . . ". Limit of Insurance* 4 , 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 FIR ST 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: •';'..,; ; --',_,,s-• :- •' ,.' ; •:,'•'...•••; Employee Dishoneaty:. . ., . . , Equipment Breakdown: $1,000 , Money and Securities:* , . ' $250 Other deductibles may apply-refer fo polidy." ' , . ' 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 iri these'Declaration , unless indicated by"See schedule". If a coverage does not have a corresponding limit shown below, but has"Included" indicatM;;refer to that policy provision for an explanation of that Coverage, . , , Coverage . Limit of Insurance., •r , -—-, -- Accounts Receivable ,, , . • • ,.: See Schedule ,. • , • ' Arson Reward $5,000 ' . Back-up of Sewer or Drain See Schedule ..1',! c•:•• I 1 ..:. ,. 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' Policy number:97-CP-D437-8Page 2 of 6 Prepared:December 15,2021 0 Copyright,'State Firm Mutual Automobile'Insurance Company, 2005 CMP-4000 • • L] • - 06 StateFarr o • Coverage -,, Limit of Insurance • !: L - '. Increased Cost of Construction.and Demolition Costs(applies-only when buildings are insured on-a 10% -• - - .. r �.." replacement cost basis) • Money Orders and Counterfeit Money ' • ' $1,000 . • . • . • § Money and Securities See Schedule . 0 $ Newly Acquired Business Personal Property(applies only if this policy provides Coverage B-Business $100,000 co o 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 See Schedule Property) • • Signs , • - . See Schedule - -- . Valuable Papers and Records - - See Schedule - - Water Damage, Other Liquids,Powder or-Molten Material Damage -- Included - .. SECTION I—EXTENSIONS OF COVERAGE-LIMITOF 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 $2,500 B-Business Personal Property) - - Signs $5,000 ' ' • Policy number:97-CP-D437-8 .Page 3 of 6, Prepared:December 15,2021 ©Copyright, State Farm Mutual.Autorhobile,Insurance.Company,.2008 CMP-4000 000994 090 State Fanny 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 S $10,000 - • - - Off Premises Limit . • • -• $5,000 •• • Outdoor Property - •. .. $5,000•" -Property of Others(applies only to those premises provided-Coverage - $2,500 - • B-Business Personal Property) = : . . Signs .. $5,000 - _ Valuable Papers and Records . . • • " - • On Premises Limit , $10,000 "• - . • -• ,.... . Off Premises Limit - - - $5,000 , • • - • ' - •i 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 . . -• " .. . _ . 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:December 15,2021 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 . CMP-4000 LI State Farme SECTION II-DEDUCTIBLES DI Property Damage: $250 • Other deductibles may apply-refer to policy.' SECTION II-LIABILITY . Coverage Limit of Insurance • • to F3 Coverage L-Business Liability Per Occurrence $1,000,000 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 General Aggregate $2,000,000 Products/Completed Operations 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: NIA ' CITY OF ASHLAND 90 N Mountain Ave • Ashland OR 97520-2014 FULL NAMED INSURED Policy number:97-CP-D437-8 Page 5 of 6 Prepared:December 15,2021 ©Copyright, State Farm Mutual.Automobile.Insurance Company, 2008 • CMP-4000 000995 c b StateFarmo 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 signed by its President and Secretary at Bloomington, Illinois. - ' .//44,4440, /1/1"."-Q1---4/: 4,-‘2 • President . Secretary V " • • +l t. Policy number:97-CP-D437-8 V Page 6 of 6 Prepared:December 15,2021 ©Copyright,=State Farm'Mutual Autbrnobile Insurance'Compahy, 2008 • CMP-4000 OL Le rdrrn ai k,nyune • PO Box 853925 Statefarm® Richardson, TX 7508&3925 `o State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois r� t�• 90_N MOUNTAIN AVE ASHLAND OR 97520-2014 • • • Inland Marine Attaching Declarations Policy number: 97-CP-D437-8 Effective date: December 7,2021 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 MortgageeiLienholder written notice in compliance with the policy provisions oras 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 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 FE-8754 Inland Marine Dealers-Service Form $500 $374 Policy number:97-CP-D437-8 Page 1 of 2 . Prepared:December 15,2021 . ©Copyright, State Farm Mutual Automobile Insurance Company, 2008;.. CIM Att Dec 3P OR.1 50-6007 1009451 2002 153089 202 03-06-2021 000996 QState� -� arm® Endorsement Coverage , Limit of insurance Deductible amount:. Annual premium number 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. • . • • f:5::�.i . a1 ,, t-,�. • .1 . .,. .. .. , . f i,:‘.. ',t.l• :y'.• -h., -. : . . Policy number:97-CP-D437-8 Page 2 of 2' Prepared:December 15,2021 ©'Copyright, State Farm Mutual Automobile'Insurance Cohpany, 2008 FD-6007