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HomeMy WebLinkAboutInsurance Certificate Amnd : Better View LLC DBA Farrell's Glass Service rrrr a..1 f1nIY1 I InL.I1nv V I I VVMI-R,1,11 U O A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,ILLINOIS DECLARATIONS AMENDED APR 9 2020 O'O® Po 6ox 853925 PolicyNumber 97-E6-2511-4 ac ardson, TX 75085-3925 Addl Insured-Section II Only Policy Period Effective Date Expiration Date M-15-2134-FAE6 F N 12 Months JUN 27 2019 JUN 272020 000995 3123 The policy period begins and ends at 12:01 am standard CITY OF ASHLAND time at the premises-Location. 20 E MAIN ST ... , ASHLAND OR 97520-1814 7 Named Insured e. _ BETTER VIEW LLC DBA FARRELL'S GLASS SERVICE. , . PO BOX 849 IIlIll1lllllIllIIllI'I'III'llllllllIIIIllllllllll"1"1111lllll'I MEDFORD OR 97501-0061 0 . I. . - . . . , - wo Auto Services Policy ' . .. . Automatic Renewal-If the policy period is shown as 12 months,this policy will be renewed automatically su bjectto the premiums,rules and forms in effect for each succeeding policy period.If this policy is terminated,weWill give you and the Mortgagee/Lienholder written notice in compliance with the policy,provisions or as required by law. Entity: Limited Liability Company ! , Reason for Declarations: Your policy is amended APR 9 2020 ADDL INSURED INFORMATION CHANGED - PREMIUM ADJUSTMENT: . - •i • . • • . , FORM CMP-4684 CHANGED • Endorsement Premium None , Discounts Applied: Renewal Year • ' • . Years in Business' Protective Devices } , • . . Claim Record . Prepared . • MAY 05 2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 OR Includes copyrighted material of Insurance Service' Offibe,Inc.,with its permission. 007740 290 Al Continued on Reverse Side of Page Page 1 of 6 DECLARATIONS(CONTINUED) Auto Services Policy for CITY OF ASHLAND Policy Number 97-E6-2511-4 . SECTION I- PROPERTY SCHEDULE. Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase- Premises Coverage A- Coverage B.- Business Buildings .. _ Business Personal Personal Property ; • Property, 001 229 S FRONT ST $ 554;700 $ 75,700 25% MEDFORD OR 97501-7263 *As of the effective date of this policy, the Limit of Insurance.ae shown includes any,increase in the limit due to Inflation Coverage. SECTION I- NFLAT ON COVERA E INDEX ES Cov A- Inflation Coverage Index: 174.4 Coy B - Consumer Price Index: 254.2 SECTION I- DEDUCTIBLES Basic Deductible $500 Special Deductibles: . Money and Securities $250 Garagekeepers- Collision $500 Garagekeepers- Comprehensive $250 Employee Dishonesty $250 Equipment Breakdown $500 Other deductibles may apply- refer to policy. Prepared MAY 05 2020 ,©Copyright,State Farm Mutual Automobile Insurance.Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 007740 . . Continued on Next Page Page 2 of 6 JUIICOWill - U O o-O® DECLARATIONS(CONTINUED) ' Auto Services Policy for CITY OF ASHLAND ! Policy,Number 97-E6-2511-4 i i j 1:6; 1 • 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, wo but has"Included" indicated, please refer to that policy provision for an'explanation of that coverage. LIMIT OF COVERAGEL• , INSURANCE ,Accounts Receivable • On Premises $10,000 Off Premises ' $5,000 Arson Reward $5,000 Back-Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non-Owned Buildings From Theft, Burglary Or Robbery ; Coverage B Limit Debris Removal , ,. 25%of covered loss Employee Tools (applies only to those premises provided Coverage B- Business Personal Property) Per Occurrence .i . $2;500 Per Employee $500 Equipment Breakdown f Included Fire Department Service Charge • $5,000 Fire Extinguisher Systems Recharge Expense • • - ' $5,000 • Forgery Or Alteration $10,000 • Garagekeeper's Insurance- Comprehensive And Collision $25,000 . Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are . 10% insured on a replacement cost basis) . • Money And Securities (Off Premises) { , . .. .. $5,000 Money And Securities (On Premises) $10,000 Prepared MAY 05 2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Service' Office,Inc.,with its permission. 007741 290 'Continued on Reverse Side of Page Page 3 of 6 DECLARATIONS(CONTINUED) Auto Services Policy for CITY OF ASHLAND Policy Number 97-E6-2511-4 • Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property(applies only if this policy provides $100,000 Coverage B- Business Personal Property) Newly Acquired Or Constructed Buildings;(a'pplies-only if this policy provides $250,000 Coverage A- Buildings) Ordinance Or Law- Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B-Business $2,500 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $20,000 Preservation Of Property 30 Days 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 $10,000 Off Premises $5,000 Water Damage, Other Liquids, Powder Or Molten Material Damage 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. LIMIT OF COVERAGE INSURANCE Employee Dishonesty $10,000 Loss Of Income And Extra Expense ' ActualLo'ss Sustained- 12 Months • Prepared MAY 05 2020 ®Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 007741 ; Continued on Next Page Page 4 of 6 O o-o DECLARATIONS(CONTINUED) Auto Services Policy for CITY OF ASHLAND ' Policy Number 97-E6-2511-4 • SECTION II- DEDUCTIBLES . • .• • $ Business Liability- Property Damage $250 ' ILA Other deductibles may apply- refer to policy. ' - ( SECTION II- LIABILITY LIMIT OF COVERAGE I ,.,. INSURANCE Coverage L- Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS 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-4684 "Addl Insd Owners Lessee Sched CMP-4412 Operation of Customers.Auto I ' CMP-4827.1 Employee Tool Coverage 1 FE-6999.2 Terrorism Insurance Coy Notice CMP-4237.1 Amendatory Endorsement Prepared MAY 05 2020 ©Copyright,State Farm Mutual Automobile'Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. . 007742 290 Continued on Reverse Side of Page Page 5 of 6 N � " . DECLARATIONS(CONTINUED) • Auto Services Policy for.CITY OF ASHLAND Policy Number 97-E6-2511-4 CMP-4705.2 Loss of Income & Extra Expnse CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4744 Garagekeepers Direct Coverage . CMP-4706 Back-Up of Sewer or Drain . CMP-4683 Addl Ins Owners Lessee Blkt CMP-4788 Addl Insd Mgrs Lessor of Prem FE-3650 Actual Cash Vlue Endorsement CMP-4742.1 Garage Liability CMP-4561.1 Policy Endorsement CMP-4527 Excl Ctrl Substances CMP-4860 Al Design Person Org CMP-4787 Waiver of Trans Rgt of Recov FD-6007 Inland Marine Attach Dec * New Form Attached 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. Secretary President . • • Prepared MAY 05 2020 .©Copyright,State•Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 007742 290 Page. 6 of 6 JLdLCrdn►► ti I Al t I-AMM Mit it ANL CASUALTY COMPANY ` O A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,ILLINOIS INLAND MARINE ATTACHING DECLARATIONS11 Po18ox85392� 7508539255kI Policy Number 97-E6-2511-4 Ric ardson, Named Insured 1 Policy Period Effective Date Expiration Date M-15-2134-FAE6 F N 12 Months JUN 27 2019 JUN 27 2020 .The policy period begins and ends at 12:01 am standard BETTER VIEW LLC time atthe premises-location. DBA FARRELL'S GLASS SERVICE PO BOX 849 . • r.1,..4 . MEDFORD. OR 97501-0061. • . $ I . ATTACHING INLAND MARINE Automatic Renewal-If the 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 Included . The above Premium Amount is included in the Policy Premium shown on the Declarations. li 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 subsequentto the issuance of this policy. - . Forms,Options,and Endorsements FE-8739 Inland Marine Conditions FE-6867 Amend of Inland Marine Condtns FE-8743.1 Inland Marine Computer Prop See Reverse for Schedule Page with Limits . . Prepared • MAY 05 2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 007743 ' Igan_aaa n 9.ng 91 g1111 I,P3,14.3-1 ATTACHING INLAND MARINE SCHEDULE PAGE • ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM • FE-8743.1 Inland Marine Computer Prop• 5 25,000 S 500 Included Loss of Income and Extra Expense S 25,000 Included • • • OTHER LIMITS AND EXCLUSIONS MAY APPLY-REFER TO YOUR POLICY Prepared MAY 05 2020 ®Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 007743 530-055 82 05-31-2011 181(3233c