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HomeMy WebLinkAboutInsurance Certificate: Emerging Futures Youth Network State Farm at CityLine U PO Box 853925 Q /� Richardson, TX 750853925 OO State Farms __ ' 000049 1200 ' AT1 State Farm Fire and Casualty Company ,, CITY OF ASHLAND A stock company with ho'me.offices iriBloorningtbn,.Illinois T. 20 E MAIN ST r._-.c. ASHLAND OR 97520-1814 , , ._ " _ _ . " 0 ,2.71 iiiiI'lllriiiiiiii'liiiiilll diiiiiiiiiiiiiiiiiiillr'iiiiiii'll . .o • :);i;,:.J Yii- ,,- .),i.10:-,,A. ! t'. ;iiia" ,: .;e:ie ,, Renewal.- Declarations . ,, . . . . , -,,. , ,,,„,,,,..c.,..;:„, ., „,,,:,,,,„ . . . . . Policy number: 97-CK-S482-9 Effective date: October 16, 2020 ' Policy period: 12 months Expiration date: October 16, 2021 : •:;': E - - The policy period begins and ends at 12:01 am standard time at the premises location. . , 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 and the ' Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. ' ' y - ' . NAMED INSURED • EMERGING FUTURES YOUTH NETWORK' .. 1180 Park St Ashland OR 97520-3535 - ' . • ENTITY . Nonprofit " , . IMPORTANT MESSAGE(S) " . Notice -Information concerning changes in your policy language is included.Please call your agent if you have any questions: Construction: frame Zone:-64 Subzone: 02 - - .. _ - POLICYPREMIUM ' ' . . . 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 " ' ' Discounts applied: Business Experience Rating - Years in Business -- - Business in Residence Premises Policy Number:97-CK-S 482-9 - ' ' Page 1 of 5 Prepared:August 8,2020 ©Copyright;State Farm Mutual Automobile Insurance Company,2008 CMP Dec 3P OR 1009482 2002 153090 202 05-05-2020 CMP-4000 66 StateFarm° SECTION I:-PROPERTY SCHEDULE ' • s : ' " 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 11.80 Park St No Coverage $1,100,; " • .' '25%, " Ashland OR 97520-3535 *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 _ . ,$1,000, , i • . SPECIAL DEDUCTIBLES: . Equipment Breakdown: $1,000 , • ,.. Money and Securities: $250 Other deductibles may apply-refer to policy. . . SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-EACH DESCRIBED PREMISES. 1, . .. �s 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, 'i' ''tr ':•F: • • Coverage Limit of Insurance ' Accounts Receivable . ,•.• ' . ' On Premises $10,000 L Off Premises $5,000• ` Arson Reward . , $5,000 Collapse - Included "�''` ' Damage'to Non-owned Buildings from Theft,Burglary or Robbery .-Coverge'B Limit., . ' ' . Debris Removal 25%of covered loss . Equipment Breakdown Included Fire Department Service Charge •$2500.1 Fire Extinguisher,Systems Recharge Expense • $5,000 Forgery or Alteration • $10,000 Glass Expenses . , . Included . • Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a 10% replacement cost basis) Policy Number;97-CK-S482-9 Page 2'of5 Prepared:August 8,2020 ''©.Copyright,State'Farm Mutual Automobile Insurance Company;2008 . CMP-4000 • u StateFarm® Coverage Limit of Insurance ';r Money Orders and Counterfeit Money. $1,000 Money and Securities On Premises $5,000 O Off Premises• . _ _.. $2,000 - _. • COo 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 provided Coverage A-Buildings) ,.$250,.000 Ordinance or Law-Equipment Coverage Included .;Outdoor Property $5,000" , . Personal Effects(applies only to those premises provided Coverage B-Business Personal Property) $2;500 Personal Property Off Premises $15,000 • Pollutant Clean Up and Removal $10,000 ' . ' Preservation of Property r, , , .-v •,30 days - Property of Others(applies only to those premises provided Coverage,B-Business Personal'Property) ,.;$2,500 N Signs $.2,500 Valuable Papers and Records On Premises $10,000 . , Off Premises .$5,000.' • Water Damage, Other Liquids,Powder or Molten Material Damage Includ4 I `' '' �'' '=`''' :.1 s SECTION I-EXTENSIONS OF COVERAGE-(LIMITOF.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 ofInsurance Loss of Income and Extra Expense • 12 Months Actual Loss Sustained ,:,:. .., •.�; .: ,. as SECTION II-LOCATION SCHEDULE Location Location of described premises , 001 1180 Park St Ashland OR 97520-3535 SECTION II-LIABILITY Coverage Limit of Insurance Coverage L-Business Liability Per Occurrence $2,000,000' Policy Number:97-CK-S482-9 • . ,. ,Page 3,of 5 Prepared:August 8,2020 - ©Copyright,State Farm Mutual Automobile Insurance Company;2008 CMP-4000 , 000259 Coverage - '. Limit of Insurance ' Coverage M-Medical Expenses. $5,000 Any One Person " .' Damage to Premises Rented to You $300,000 . Aggregate Limits ' Limit of Insurance - • Products/Completed Operations Aggregate - - - ' $4;000,000" General Aggregate $4,000,000 Each paidclaim 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-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-4787 Waiver of Transfer of Rights of Recovery Against Others To Us ' • - CMP-4788 Additional Insured-Managers or Lessors of Premises ' - ' ' , FD-6007, Inland Marine Attaching Declarations • FE-3650 " Actual Cash Value Endorsement • - - FE-6999.2 Policyholder Disclosure Notice of Terrorism Insurance Coverage • ' *New Form Attached SCHEDULE OF ADDITIONAL INTEREST(S): , Interest type: Managers or Lessors of Premises ' , Interest type: Designated Person or Organization, Endorsement dumber: CMP-4788 '.`w`-Ir" ';-VYEndorsehientnumber•' • LP'••/: `-: •°•• '''- 'a:'` , . : ' w 4 '4.: Loan.number: N/A ,Loan number: N/A' • , . , City of Ashland ' ' City of Ashland • 20 E Main St 20 E Main'St , Ashland'OR 97520-1814 Ashland OR.97520-1814 . . This policy is issuedby 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 Di`Fectors 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. ' ' ,• , President Secretary . Policy Number:97-CK-S482-9 "' . Page 4 of 5 Prepared:August 8,2020 ©Copyright,State Farm Mutual Automobile Insurance Company;2008 ' CMP-4000 ' u &'State Farm® NOTICE TO POLICYHOLDER: ' rr For a comprehensive description of coverage and forms, please refer to your policy. • Policy changes requested before the "Date Prepared",which appear on this notice, are effective on the'Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder,'or amended declarations: Any coverage forms attached to this notice g are also effective on the Renewal Date of this policy. o , Policy changes requested after the"Date Prepared"will be sent to you as an amended declarations or as an endorsement to your policy, Billing for any additional premium for such changes will be,mailed at a later date. If, during the past year, you've acquired any valuable property items, made any,improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent Please keep this with your policy. Your coverage amount.... It is up to you to choose the coverage and limits that meet your needs. We recommend that you purchase a coverage limit equal to the estimated replacement cost of your structure, Replacement cost estimates.are available from building contractors and replacement cost appraisers,or, your agent can provide an estimate from Xactware, Inc. using information you provide about your structure. State Farm does not guarantee that any estimate will be theactual future cost to rebuild your structure. Higher limits are available at higher premiums., Lower limits are also available, as long as the amount of coverage meets our Underwriting requirements. We encourage you to periodically review your coverages and limits with your agent and to notify us of any changes or additions to your structure. • • • Policy Number:97-CK-S482-9 Page 5 of 5 Prepared:August 8,2020 ' ' ©Copyright,State Farm Mutual Automobile Insurance Company,2008 ' CMP-4000 State Farm at CityLine U PO Box 853925 Richardson, TX 75085-39253 � tateFarrr► State Farm Fire and Casualty Company ,,.. CITY OF ASHLAND . A stockcompany with home offices in Bloomington, Illinois ;�. 20 E MAIN ST ASHLAND OR 97520-1814 S • p . Inland Marine Attaching Declarations Policy number: 97-CK-S482-9 Effective date: October 16, 2020 Policy period: 12 months Expiration date:.October 16, 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 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 CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issuedsubsequent to the issuance of this policy. FORMS,OPTIONS AND ENDORSEMENTS FE-6867 InlandMarine 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 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-CK-S482-9 i Page 1 of 1 Prepared:August 8,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM AttDec 3P OR 1009481 2001 153089 201 12.04-2018 FD-6007 000261