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HomeMy WebLinkAboutInsurance Certificate Amnd: Better View LLC dba Farrells State Farm at CityLine . `-' PO Box 853925 • . , Richardson, TX 75085;3925 0 StateFarina AT2 000342 1200 01 . State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home;offices'in,Blobrnington;rlllihois it 20EMAIN ST -1.:,-T-..' � ASHLAND OR 97520-1814 , . �o IhligIIIIIIIIIII�lluillIIIInilllIllllunli,lIIIIII�llllil�II� . coo • Amended Declarations :,..:;.t:„:,!.3i1...:-.,,c.! !.,?!or - -4:.! f ,. Policy number: 97-AA-B135-1 Effective date: November 11,2020 ' Policy period: 12 months Expiration date: June 27, 2021 ' The policy period begins and ends at 12.01 am standard time at the premises location. AUTO SERVICES 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 , MortgageelLienholder written notice incompliance with`the'policyprovisions or.•as required by`la v .(' NAMED INSURED. .. BETTER VIEW LLC DBA FARRELL'S , ' , 229 S FRONT ST - MEDFORD OR 97501-7263 • . ' ENTITY ' ' Limited Liability Company REASONS FOR DECLARATIONS ,. •Your policy is'amended effective November 1"1; 2020 dtie.to some recent policy changes you:requested.Enclosedis a copy`of your• new endorsements, if any. POLICY PREMIUM . . ' This is not a bill.!fan 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: $5,174.00 , ' Discounts applied: r; - Business Experience Rating Renewal Discount ' ' Protective Devices Years in Business ' Policy Number:97-AA-B135-1 ' Page 1'of,5 Prepared:November 20,2020 '©Copyright,State Farm Mutual Automobile Insurance Company,2008 ' CMP Dec 3P OR 1009482 2002 153090 202.06-05-2020 CMP-4000 ' 001517 ' • b a StateFal ina • 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 001 229 S FRONT ST $589,700 $76,909,5, r 25% ., • MEDFORD OR 97501-7263 *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: 185.4 Coy B-Consumer Price Index: 258.7 SECTION I-DEDUCTIBLES BASIC DEDUCTIBLE $500, SPECIAL DEDUCTIBLES: Employee Dishonesty: ' $250 Equipment Breakdown: $500 ,Garagekeepers-Collision: $500 . Garagekeepers-Comprehensive: $250 Money and Securities: $250 Other deductibles 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"j:ndieated;`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 ;4 } ; Y Arson,Reward . . $5,000: Back-up of Sewer or Drain $15,000 Collapse Included Damagee•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 Employee $500 Per Occurrence $2,500 Equipment Breakdown Included . -Policy Number:97-AA-B135-1 Page 2 of 5 Prepared:November 20,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 . v L., 09c,StateFarme Coverage Limit of Insurance' t g+ Fire Department Service Charge $5,000 ` ' Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration $10,000 oGaragekeepers Insurance-Direct Coverage $25,000 Glass Expenses Included. , Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a 10% • ' • replacement cost basis) •: „ - • Money Orders and Counterfeit,Money $1,000 Money and Securities ' ' On Premises $10,000" • Off Premises $5,000 . 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 " . .. -._ 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 $20,000 Preservation of Property30 days . , • Property of Others(applies only to those premises provided Coverage B-Business Personal Property) $2,500 ' . Signs $5,000 {';;:d': • , , . , 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 . • $10,000,. , - , • Loss of Income and Extra Expense .12 Months Actual Loss Sustained Policy Number:97-AA-B135-1 Page 3 of 5 Prepared:November 20,2020 •©Copyright:State Farm Mutual Automobile Insurance Company,2008 - CMP-4000 , 001518 . o o StateFarm SECTION II-LOCATION SCHEDULE. . . , Location Location of described premises ' number . .. '. . _ ... 001 229 S FRONT ST MEDFORD OR 97501-7263' ' SECTION II-DEDUCTIBLES ' _ .. .. ' Property Damage: . $250 ' _ . . ' Other deductibles may apply_refer to policy.:' , - . . . SECTION II LIABILITY. . . . .. . Coverage Limit of Insurance _. Coverage L-Business Liability Per Occurrence .... $1,000,000 Coverage M-Medical Expenses . , _ .. $5,000 Any One Person - Damage to Premises Rented,to You . _ . . . $300,000 . . Garage Liability - Included in.Coverage L Operation of Customers'Auto on Particular Premises;, , ,Included, , , _ Aggregate Limits-. . - - _- .Limit of 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 aswell as those issued subsequent to the issuance of this policy. " ,, . ; FORMS AND ENDORSEMENTS il CMP-4100 Businessowners Coverage Form CMP-4237.1. , Amendatory Endorsement(Oregon).. • . . .. CMP-4412 Operation•of Customers'Auto'on Particular Premises ' .. CMP-4527 ..Marijuana Exclusion . . _ . CMP-4543 Additional Insured-Designated.Person or Organization CMP-4561.1 Policy Endorsement .. . CMP-4683.1 . Additional Insured .Owners,Lessees or Contractors(Blanket) Y .. , , CMP-4684.1 •Additional Insured-Owners,Lessees or Contractors(Scheduled) . •• . - . . . CMP-4705.2 Loss of Income and Extra Expense . . : • CMP-4706 Back-up of Sewer or Drain 'i •°:-'" '_ ' '' ' . :'-:',1 : _ ,. . , •s ,. .. :E: . 1 !;` „ CMP-4709 . . Money and Securities . CMP-4710 Employee Dishonesty " " CMP-4742.9 Garage Liability • CMP-4744 Garagekeeper's Insurance'-Direct Coverage CMP-4787 Waiver offiTransfer'of Rights of Recovery Against Others To Us . CMP-4788 "Additional Insured-Managers or Lessors of Premises '.. . . • - ' - .. • .. - CMP-4827.1 Employee Tool Coverage FD-6007 Inland Marine Attaching Declarations FE-3650 Actual Cash Value Endorsement Policy Number:97-AA-8135-1 '' , • Page 4 of 5 Prepared:November 20,2020 '©Copyright,'State Farm Mutual Automobile Insurance Company;2008 CMP-4000 , u o StateFarn® FE-6999.2 Policyholder Disclosure Notice of Terrorism,Insurance Coverage SCHEDULE OF ADDITIONAL INTEREST(S) Interest type: Owners,Lessees,or Contractors(Schedul Endorsement number: CMP-4684.1 Loan number: N/A $ CITY OF ASHLAND 20 E Main St o Ashland OR 97520-1814 FULL NAMED INSURED Named Insured: BETTER VIEW LLC DBA FARRELL'S GLASS SERVICE 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. President Secretary Policy Number:97-AA-B135-1 Page 5 of 5'. Prepared:November 20,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 001519 State Farm at CityLine PO Box 853925 Richardson, TX"75085 3925 0°0 StateFa/�me State Farm Fire and Casualty Company itCITY OF ASHLAND Astock company with home offices in Bloomington, Illinois 20EMAIN ST. ASHLAND OR 97520-1814 " 0 • • 0 0 Inland MarineAttaching Declarations Policy number: 97-M-6135-1 Effective date: November 11, 2020 Policy period: 12 months Expiration date: June 27, 2021 The policy period begins and ends at 12:01 am standard time at the premises location, ATTACHING INLAND MARINE Automatic renewal -.lithe State Farms 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 writteh 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: BETTER VIEW LLC DBA FARRELL'S GLASS SERVICE 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 Form $25,000 $500 Included Loss of Income and Extra Expense $25,000 Included • • Policy Number:97-AA-8135-1 Page 1 of 2 Prepared:November 20,2020 •©.Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR 1009481 2001 153069 201 12-04-2018 FD-6007 001520 St tOOFa ffIs • • 'Otherrlimits'and exclusions may apply refer to your policy. • • • • % • ti 4•P . n • Policy Number:97-AA-B135-1 Page 2 of 2 Prepared:November 20,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 .. FD-6007' u CMP-4684.1 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES, OR CONTRACTORS'(Scheduled) This endorsement modifies insurance provided under the following:• BUSINESSOWNERS COVERAGE FORM • SCHEDULE Policy Number: 97-AA-B135-1 Named Insured: BETTER VIEW LLC DBA FARRELL'S GLASS SERVICE 20 E Main St Ashland OR 97520-1814 Name And Address Of Additional Insured Person Or Organization: CITY OF ASHLAND 20 E Main St Ashland OR 97520-1814 1. SECTION II —WHO IS AN INSURED of SECTION II —LIABILITY is amended to include; as an additional insured, any person or organization shown in the Schedule, but only: a. Ongoing Operations With respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused by your ongoing operations for that additional insured and only to the extent that such "bodily injury",, "property damage" or `:personal and advertising injury" is caused by your negligence or the negligence of those performing operations on your behalf; or b. Products-Completed Operations To the extent that the liability for"bodily injury" or"property damage" is caused by "your work" performed for that additional insured and included in the"products-completed operations hazard". ' 2. Any insurance provided to the additional insured shall only apply with respect to a claim'made or a"suit" brought for damages for which you are provided coverage. 3. Primary Insurance, The insurance afforded the additionalinsured shalt be primary insurance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you.. All other policy provisions apply. CMP-4684.1 155042 03-20-2019 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2018 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 001521 $. • • • • • • • • 5{i •. . , • • • • • W • • • • • • :i� _ e .