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HomeMy WebLinkAboutInsurance Certificate Amnd: Wild River Surveying LLC State Farm at CityLine U PO Box 853925 Farm Richardson, TX 7508. - 9255 OO State ® 0006161200 - : . _ . . . _. AT1 State-Farm Fire.and.Casualty Company ti THE CITY OF ASHLAND A stock company with home offices in Bldorriington;1llinois 20'E MAIN ST :., ASHLAND OR 97520-1814 . a o . g 1111111111111111111111111I'Ill'IIlIi111111111111Iiilri1111111rli1 • Amended: Declarations . - ; : : , ,' - -:-.- Policy number: 97-CN-X256-3 Effective date; June.1', 2020., i,:.r,,,-„,,,,::::!,.. 01,Flk,,,:-.•,-_';,1:-; ?!.;1'..1-'n '. ••',......*:.•2L,; ,, - ' , Policy period: 12 months •Expiration date:.January 24, 2021 The policy period begins and ends at 12:01 am standard time at the premises location. ;v° v, ?._ `.; 'F , BUSINESSOWNiRS 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 compliance with the policy provisions or as required by law. • • ; NAMED INSURED . ..,�,r ,..--,:..,t.,-,_ -.J ''' .,:-..t' ,y... ,< , . _ f, F +u:r,-,: ' WILD RIVERS.;SURVEYING•LLC; -.. • . • 3339 GREEN ACRES DR . - ,. • • , CENTRAL POINT OR 97502-1413 ENTITY Limited'Liability Company ... .'." ' - _•. ._., ; . . _. . .. . . IMPORTANT MESSAGE(S) _ - - 'Construction: frame Zone:64 Subzone:02i�•- _ - REASONS FOR DECLARATIONS Your policy is amended effective June 1,'2020 due to some recent policy changes you requested.Enclosed is a copy of'your new . endorsements, endorsements, iif any, . : • . . . - . . . .. POLICYPREMIUM :, _. . ._ This is not a bill.if an amount is due, thn;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: $371.00 , - .•. . __ , - ' 1. Policy Number:97-CN-X256-3 • Page,1 of 5 Prepared:June 1,2020 ' ©Copyright,State Farm Mutual Automobile Insurance Company,2008 . '. , CMP Dec 3P OR 1009482 2002 153090 202.03-22-2020 CMP-4000 mmnao • 'o-t.../StateFNI m® Discounts applied: , Business Experience Rating Renewal Discount .• Business in Residence Premises • 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 3339 GREEN ACRES DR No Coverage $26,700 25% CENTRAL POINT OR 97502-1413 *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 . Cov B-Consumer Price Index: 256.8 SECTION I—DEDUCTIBLES < BASIC DEDUCTIBLE $500 • , SPECIAL DEDUCTIBLES: : i- .; :: '.;:.;b; :•... ; '; Employee Di§honesty:, • $250 . Equipment Breakdown: $500` • ' •"' Money and Securities: $250 • , Other dedubtibles 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 7 Policy Number:97-CN-X256;3 Page 2 of Prepared June],2020 •`©Copyright,State Farm Mutual'Automobile Insurance Company,2008 .CMP-4000 U o StateFarm° Coverage Limit of Insurance y , ,t".+ -,i f,4,C• -+=_ 1,• Forgery or Alteration •$10;000`` " ' • Glass Expenses Included Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a 10°6 § replacement cost basis) OMoney Orders and Counterfeit Money $1,000 Money and Securities On Premises $5,000 • , Off Premises $2,000 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 - Outdoor Property $5,000 I - . Personal Effects,(applies only to those premises provided Coverage B-Bueiness,Personal Property);;,, $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 $4500 Valuable Papers and Records On Premises r • •$10;000 Off Premises $5,000 Water Damage, Other Liquids,Powder or Molten Material Damage ,: • I•• 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 premises shown in these Declarations. Coverage Limit of Insurance Employee Dishonesty $5,000 , Loss of Income and Extra Expense 12 Months Actual,Loss Sustained • Policy Number:97-CN-X256-3 ' . Page 3 of 5 Prepared:June 1,2020 ,.©Copyright;StateFarm Mutual Automobile Insurance.Company,2008 I CMP-4000 003033 • , . . . , 090 State Farme • . ... .. , . . . . SECTION II-LOCATION SCHEDULE . . . . . .... . _ . .. . .. . . .. . ., . .., . ... Location Location of described premiss'-- • • • . .. number .. . . •... . . . . . , . 001 3339 GREEN ACRES DR- -- - •- - , • CENTRAL POINT OR 97502-1413 • , SECTION II-LIABILITY . • . . . . .. . . . _. . .. . . . . Coverage Limit of Insurance - - . Coverage L-Business Liability Per Occurrence • $2,000,000 . • Coverage M-Medical Expenses , , . $10,000 Any One Person . .. , . . Damage to Premises Rented to You ' • • . „ . . .. - • . Aggregate Limits .. ,-, .. ,-- -. -1 .Li'rnit of Insurance. ..„ • , , . , , Products/Completed Operations Aggregate , ,, $5,000,000 . , , . . General Aggregate .•.. • $5,000,000 Each paid claim for Liability Coverage reduces the amount of itisurariCe we provide during.the applicable annual period. Please refer to Section Il- Liability in the Coverage Form and any attaChed.endorsenents. . . .. .• . . ., . _ . Your policy consists of these Declarations,the BUSINESSOWNERS COVERAGE FORM shown'below,and any other forms and endorsernents.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-4683.1 .Additional Insured-Owners,•Lessees or Contractors(Blanket) . - CMP-4684.1 Additional Insured-Owners,Lessees or Contractors(Scheduled) CMP-4705.2 . Loss of Ihcome and Extra Expense • — .- . CMP-4709 Money and Securities , * CMP-4710 - Employee-Dishonesty • , . . - CMP-4787 Waiver of Transfer of Rights of Recovery Against Others To Us .' r ' - . ‘ ' , • .-,.,- • , - - CMP-4788 - 'Additional Insured-Managers or Lessors-of Premises- - - FD-6007 Inland Marine Attaching Declarations .,., :j.i,.-‹ •,. -..; .. . i. , ,, w : . ., ;I:. ,i, - , • •,y ,,, i ,.:, A::..,,, •,-.: )., % : , .,_, . ..‘:.),,,• ,,,-,-- FE-3650 Actual Cash Value Endorsement •, FE-6999.2 , , Policyholder Disclosure Notice of Terrorism Insurance Coverage , • . . . . • ,. . *New Form Attached ' . , . . . . . . . • , ' ,, , . . . . • ' . ' , . . • , • 'Policy Number:97-CN-X256-3 _ • • ' 'Page•4 of 5 Prepared:June 1,2020 , ' '©Copyright;State Farm Mutual Automobile Insurance Company,2008 ' , CACMP-4000 ,0 . u. o StateFarm° 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. ge In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at o Bloomington, Illinois. le� *).L14.4)1/1.:yotaat, President Secretary • • • • • Policy Number:97-CN-X256-3 Page 5 of 5 Prepared:June 1,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 nnanae State Farm at CityLine U PO Box 853925 Richardson, TX 75085-3925 StateFarina State Farm Fire and Casualty Company THE CITY OF ASHLAND . . . A stock company with home offices in Bloomington, Illinois 20 E MAIN ST ASHLAND OR 97520-1814 . . S Inland Marine Attaching Declarations i • Policy number: 97-CN-X256-3 Effective date:.June 1, 2020 Policy period: 12 months Expiration date: January 24, 2021 The,policy period begins and ends at 12:01 am'standardtime at the premises location. • ATTACHING INLAND MARIN 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 CONDITIONSshown 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 r' 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-CN-X256-3 Page 1 of 1 Prepared:June 1,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR 1009481 2001 153089 201 .12-04-2018' FD-6007 003035 •