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HomeMy WebLinkAboutInsurance Certificate Amnd : Ashland Culture of Peace Commission State Farm at CityLine U PO Box 853925 Richardson,,TX:75085 3925 00 ctateFantle v G ATI State Farm Fire and Casualty Company CITY OF ASHLAND INCLUDING ITS A stock company with hbme offices in Bloomington, Illinois Do20 E MAIN ST ASHLAND OR 97520-1814 S II i Ilnlll rll lil I Ir I nr I I to II I n II nllll III II Ill I I II I III Inn III " • " • ' Amended' Declarations Policy number: 97-AA-A892-4 Effective dater July'.1, 2020 Policy period: 12 months. Expiration'date: July 1, 2021 , The policy period begins and ends at 12:01 am standard time.at the premises location. ;�r:.J is_( •;.,w. ; :-`,.' I3USINESSOWNERS POLICY Automatic renewal -.If the State Farrn®policy period is shown as'12 months, this policy will 6e renewed automatically;subject.to the • premiums,_rules and forms in effect foreach 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 {;_.''��` i`i�..-... 'r�1� -3:.%?,�4, .r;� �1,. .t,1i ;!`.'!,r 7.;)„P1• i' . _ r': -1.... t . ... ASHLAND,•CULTURE OF PEACE COMM! ; - ., - . . 2305C ASHLAND ST#.337 , , , ;,...,; .. ; ASHLAND OR 97520-1407 ENTITY Corporation IMPORTANT MESSAGE(S) Construction: frame Zone: 64 Subzone: 02. REASONS FOR DECLARATIONS • , Your policy is amended effective July 1, 2020 due to some recent policy-changes-you requested. Enclosed is 8-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 is the 12 months premium(s)for the characteristics of the policy as described in this Declarations. Total Premium: $325.00 Minimum Premium - - '• ' . , Policy.Number:97-AA-A892-4 •• • ' Page 1 of 5 Prepared:June 30,2020 , ©•Copyright,State Farm'Mutual•Automobile Insurance Company,2008 CMP Dec 3P OR' 1009482 2002 153090 202 03-22-2020 CMP-4000' mu ` :a8.StateFarme • • Discounts applied: Business Experience Rating Renewal Discount `'' " Years in Business Business in Residence Premises SECTION I-PROPERTY SCHEDULE Location Location of described premises- Limit of Insurance* Limit of Insurance* Seasonal increase:.' number Coverage A- CoverageB-Business Business Personal Property Building ° Personal Property 002 2560 Eagle Creek Ln No Coverage $5,000 - 25%, Ashland OR 97520-3630 *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: 258.7 SECTION I-DEDUCTIBLES BASIC DEDUCTIBLE- $500 SPECIAL DEDUCTIBLES: i.' f;; ,v,: 's... 'r;:'•:";.; Employee,Dishonesty:, • . , $250• , _ Equipment'Breakdovvn: 1500' • ' ' ' - Money and Securities: ' ' ' ' • $250 ' - Other deductibles may apply=refer to`policy, r' <' • SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE=EACH DESCRIBED PREMISES fi..%"•'t 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 c',• , .,;t!,, '' 4' ; ,,;t ,:aq G•.v Collapse , Included " Damage to Non-oened'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-AA-A892-4 Page 2 of 5 Prepared:June 30,2020 • , i'©Copyright,State Farm Mutual Automobile'InsuranceCompany,2008 , CMP-4000 . ' u • • Stc teFarm Coverage Limit of Insurance Forgery or Alteration $10,000 •' ' Glass Expenses Included Increased Cost of Construction and Demolition Costs(applies only.when buildings are insured on a 10% 0 replacement cost basis) -• . $ Money 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 • • V • • • Personal Pro P er ty)• - ._ 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 Personal Effects(appliesonly tothose premises provided,,Coverage,B-Busines Personal Property) $2,500. • - . •- Personal Property Off Premises '' $15,000 • V • 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 $2:500.. _ 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. Coverage Limit,of Insurance , Employee Dishonesty V $5,000 Loss of Income and Extra Expense 12 Months Actual Loss Sustained Policy Number;97-AA-A892-4 V Page 3 of 5 Prepared;June 30,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 V ' 001153 • State Farm SECTION II-LOCATION SCHEDULET:, , • Location- Location of descnbed premises number 002 . 2560 Eagle Creek Ln. :. -.._ .:, Ashland,OR 97520-3630 SECTION II-'LIABILITY'' Coverage Limit of.Insurance , • • Coverage.L=Business Liability.Per Occurrence $2,000;000, ;,.r Coverage MI Medical Expenses .;. - $10.000,Any-One Person Damage to•Prerriises Rented:to You :;, t •,,:;.$30q,004,, Aggregate Limits ,i Limit of:,Insurance' Products/Completed Operations Aggregate • $4 000 000 , 3• ., , General Aggregate $4,000,000 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 ` CMP4100 Businessowners Coverage Form .. CMP-4237.1 Amendatory Endorsement:(Oregon) CMP=4527 Marijuana Exclusion, '_, . ` :- . CMP-4543 Additional Insured=Designated Person or Organization • _ . CMP-4561.1-- Policy Endorsement .`_ ._ . CMP-4705.2 Loss of Income and Extra_ Expense CMP-4709'_. -•Money and Securities • -• • -, ..' . * CMP-4710 Employee Dishonesty,:, tt CMP-4804 -' Additional Insured'-Club Members': • '. FD-6007 Inland:Marine Attaching Declarations : FE-3650- --Actual Cash Value Endorsement ; . FE,6999.2 Policyholder Disclosure Notice of Terrorism Insurance Coverage . t td; .c..t`jI r�d ]� f1, I,'.1 •t{.. .,!ii•,. *NewFormAtfached y`s • ,.a, r , . FULL NAMED INSURED Named Insured: ASHLAND CULTUREOF;PEACE COMMISSION • Policy Number 97-AA-A892-4; • ;Page 4 of 5 Prepared:June 30,2020 •©Copy'right,State Farm Mutual AutomobileInsurance company, CMP-4000 . , LI o o StateFarm° • • This policy is issued by the State Farm Fire and Casualty Company. r ' •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 � o Bloomington, Illinois, rn. President Secretary • • • • • • • • • • • • • • • • Policy Number 97-AA-A892-4 Page 5 of 5 Prepared:June 30,2020 ©Copyright,State'Farm Mutual Automobile Insurance Company,2008 CMP-4000 . 001154 . . . . • . . • , . . . . . . . • . . . , . " . . . , . . , . . . . .. • . d . . , . . • . • . , . . . , . .. . . • . . . . . 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' ' " •* . • • . . . . . . . .. , . . ,, State Farm at CityLine LJ PO Box 853925 -Richardson,.FX 75085-3925 p StateFa n ®" State Farm.Fire and:Casualty Company CITY OF ASHLAND INCLUDING ITS A stock company with home offices in Bloomington, Illinois 20 E MAIN ST { ASHLAND OR 97520-1814 ' p C Inland Marine Attaching Declarations: Policy number: 97-AA-A892-4 Effective date: July 1, 2020 Policy period: 12 months Expiration date: July 1, 2021 The policy period begins and ends at 12:01 am standard time at the premises location. . ATTACHING INLAND MARINA 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. Annual policy premium:.Included The above premium amount is included in the Policy Premium shown on the Declarations, FULL NAMED INSURED Named Insured: ASHLAND'CULTURE OF PEACE COMMISSION 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.' . 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 Fomi • $25,000 $500 Included Loss of Income and.Extra Expense • • $25,000 Included Policy Number:97-AA-A892-4 ' Page 1 of 2 Prepared:June 30,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 , CIM Att Dec 3P OR 1009481 2001 153089 201 12-04-2018 FD-6007 norm 1 e! • OCO StateFarm® • • Other limits and exclusions.may apply-refer to your policy, • • • • • • : 7- •') Policy Number:97-AA-A892-4 Page.2 of 2 Prepared:June 30,2020 ©Copyright,State Farm Mutual AutomobileInsurance Company,2008 .FD-6007 •