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Home My WebLink AboutInsurance Certificate Amnd: Wild Rivers Surveying LLC State Farm at CltyLine U • Ric Brdson,. TX on,x TX O'CO StateFarm 25 Richard75085-3925 � C7 0005821200- . . . • AT1 State Farm Fire and Casualty Company THE ASHLAND CITY COUNCIL • A stock company with home offices in Bloomington, Illinois` A. .! 20 E MAIN ST 1.7- ASHLAND OR 97520-1814 N IIiuiIliliirillliuIiiiruIitIIIiirl1tfllli1huiIIIlrliurI!iIIIIIi!!I i • • Amended Declarations Policy number: 97-CN-X256-3 Effective date: June 23, 2020 • 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. ' ; r;; BUSINESSOWNERS POLICY - Automatic renewal -If the State Farm®policy period is shown as 12 months, this policy will be,renewed automatically subject to the , . premiums, rulesand forms in effect for..each succeeding policy period. If this policy is terminated,:we will give you a nd,the MortgageelLienholder written notice in compliance with the policy provisions or as required by law::. - . . • NAMED INSURED „ r.1 " _. -^ 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: 02 ' ` '•• ' ' ' REASONS FOR DECLARATIONS Your policy is amended effective June 23; 2020 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 premiums)shown below is the 12 months' ' premium(s)for the characteristics of the policy as described in this Declarations. Total Premium: $376,00 Policy Number:97-CN-X256-3 Page 1 of 5, Prepared:July 6,2020 ©Copyright,State Farm Mutual Automobile Insurance Company;2008 CMP Dec 3P OR 1009482 2002 153090 202 03-22-2020 . CMP-4000 002861 • ,.I,.• tt... 68 StateFarme . 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) Coy A-Inflation Coverage Index: • N/A „ . . Coy B-Consumer Price Index: - 256.8 . • • SECTION I—DEDUCTIBLES , BASIC DEDUCTIBLE • $500 ' • . SPECIAL DEDUCTIBLES: :'51.:C:,-:•..;,':' �,; -'.:': Employee Dishonesty:. -$250 . - Equipment Breakdown: ' . $500 Money and Securities: . . . • . $250. . ' • Other deductibles may apply-refer to policy. . . c . - . ' ' SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE•EACH DESCRIBED PREMISES • L' ' �' ' 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 Policy Number:97-CN-X256-3 •Page 2 of,5 Prepared:July 6,2020 ' ©Copyright,,State Farm Mutual Automobile Insurance Company;2008. CMP-4000 ' • li. . , . . • , . . , 090 State Fartne. . ,. . . . . .. . .. . „ . , Coverage , - 1, Limit of Ins'uranCe'...,.':'?' :."-; :. :..." ::',.."1 ..,:.'' •': ,•' . . , •!f" Forgery or Alteration - $10,000'• ' -, •• c :'. . • ..%.4.1.F. . Glass Expenses • . . I ' * 'Included , I Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on.a 10% .„ ,, „ , § replacement cost basis) . 0. Money Orders and Counterfeit Money . - - • $1000 . 4 •. ;-:...-.:\.„ 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 . t : -; 1 Included . '.' ' • Outdoor Property . ' : $5,000 • Personal Effects(appliesonly to thote premises provided Coverage,B-Business Personal property) $2,500 ,.. . S. Personal Property Off Premises , ' ' '$15",000 - - : •- -- Pollutant Clean Up and Removal . ' •• • ' •• • ' - , 1 , Preservation of Property . 30 days Property of Others(applies only to those premises provided Coverage B-Business Personal Property) • $2,500 . Signs $21500 • •• ' . , . , • . Valuable Papers and Records • • . . ., , , • . , ... • On Premises S . . . , °, t•,_, . • I, : •- : $10,000 • • .•'' ' ' .. . ..',' , . Off Premises ' $5,000 . ,.. . . , Water Damage, Other Liquids,Powder or Molten Material Damage 1: • . . -•.•;:• . , . Included . . . , • ,` . - ' . • '' - ' SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY The coverages and corresponding limits shown below are thelnOst we will parregardless of tie.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 July 6,2020 ()Copyrignt,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 . i 5 , . 002862 5 ;4, oho Std ° iim® SECTION II-LOCATION SCHEDULE .., , . - i , Location Location of described premises _ • ' 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 ' . $300,000;. , I , Aggregate Limits `. . - Limit of Insurance ' Products/Completed Operations Aggregate . • , , . $5,000,000 , , , . General Aggregate S $5,000,000 . Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please,refer to Section I I-•_ 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-4683.1 Additional Insured-Owners,-Lessees or Contractors(Blanket) - CMP-4684.1 Additional Insured-Owners,Lessees or Contractors(Scheduled) , ` CMP-4705.2 Loss of Income and Extra Expense - - - CMP-4709 Money and Securities • CMP-4710 - Employee Dishonesty - - -- ". - --- CMP-4787 -CMP-4787 Waiver of Transfer of Rights;of Recovery Against Others To Us ,, 1 : ,. '' • .- CMP-4788 ' ' Additional,Insured;Managers or Lessors of Premises - - FD-6007 Inland Marine Attaching Declarations s! ,so. y;.,,:., L,,, ,t , ;) .;()-;,:,;-, r . FE-3650 Actual Cash Value Endorsement . FE-6999:2 • Policyholder Disclosure Notice of Terrorism Insurance-Coverage . ' . • . , _ . _ , • Policy Number:97-CN-X256-3 Page 4 of 5 Prepared:July 6,2020 ©Copyright,State Farm Mutual Automobile insurance Company,2008 _ . • CMP-4000 u o State Farm' This policy is issued by the State Farm Fire and Casualty Company, WA 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,, /frize-A-4.4277-17:kce-2 *.milis ryiitaato President Secretary; • I , Policy Number:97-CN-X256-3 • Page 5 of 5 Prepared:July 6,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 • 002863 State Farm at CityLine ' U PO Box 853925 ' Richardson, TX 75085 3925 0°0 StateFatal° • State Farm Fire and Casualty Company THE ASHLAND CITY COUNCIL A stock company with home offices in Bloomington, Illinois ' 20EMAIN ST c' ASHLAND.OR 97520-1814 ,,tg . Inland MarineAttaching Declarations . , . . Policy number: 97-CN-X256-3 Effective date:.June 23, 2020 , 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. 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 requiredby 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 MARINECONDITIONS 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 V FE-8739 Inland Marine Conditions . FE-8743.1 , ..Inland Marine_Computer Property Form. See below for schedule page with limits ' . ' 1 ' 1 ATTACHING INLAND MARINE SCHEDULE PAGE ' ' Endorsement Coverage Limit of insurance Deductible'amount Annual premium number • , V 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:July 6,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR 1009481 2001 153089 201 12-04-2018 FD-6007 i 002864 .