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HomeMy WebLinkAboutInsurance Certificeate Amnd: Kencairn Landscape Architecture State Farm at CityLine U PO Box 853925 • Richardson;•TX 75085 3925 f _ Q Q StateFa in AT2 000857 1200 01 State Farm Fire and CasualtyCompany CITY OF ASHLAND : A stock company with homeoffices,•in'Blooniington,.Illinois x: ATTN: TAMI DEMILLE-CAMPOS 20EMAIN ST ... .ASHLAND,OR,`97520-1814 , , S • i d'111111111111111111111111111"1.111111111111111111111'111"111 ,. -/ :t • Amended• Declarations' ., t: , „ , t , .. „ ., :„ • Policy number: 97-AA-G018-8 Effective date:.December 1, 2020 ,- - - Policy period: 12 months Expiration date: October 29, 2021 -' : ti".. • The policy period begins and ends at 12:01 am standard time at the premises location. OFFICE POLICY Automatic renewal -If the State Farm®policy.period is shownias,12 motiths;:;thisSpolicywill.be:renewed:autorhatically;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 .. •y, i. .. - . mi I '. , .a . �w.v •. =-1-'----'2'. .. Mortgagee/Lienholder'written notice-in compliance,with therpolicy•'provisions'or-as required by-law. .. -- - -- '- - --' NAMED INSURED . KENCAIRN.LANDSCAPE ARCHITECTUR 147 CENTRAL AVE , ASHLAND OR 97520-1714 - ENTITY .. " , ,"',, Limited Liability Company - REASONS FOR DECLARATIONS , - Your policy•is amended'effective)December 1,`2020 due to`som`e`recent policy changes you requested. Enclosedis a'copy of your `',. new endorsements, if any. - • POLICY PREMIUM , . • . , This is not a bill.If en 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 describedin this Declarations. . _ , . . , Total Premium: $371.00 '__ . Minimum Premium „. • Discounts applied: . . • Business Experience Rating' Renewal Discount' Years in Business - • Business i'n Residence Premises Policy Number:97-AA-G018-8 Page 1 of 5 Prepared:February 18,2021 .©Copyright,State,Farm.Mutual Automobile Insurance'Company,2008 CMP Dec 3P OR 1009482 2002 153090 202 12-05-2020 CMP-4000 ' 003839 -. 001StateFarrn SECTION1-:PROPERTYSCHEDULE ' 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 .545 A ST STE 3 No Coverage $31,600, ; , ; , ,', 25%• ASHLAND OR 97520-2051 *As of the effective date of this policy, the Limit of Insurance as shown includesany 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 SPECIAL DEDUCTIBLES: , Employee Dishonesty: $250 • Equipment Breakdown: $1,000 Money and Securities: $250 , Other deductibles may apply-refer to policy. 4 ,i; .1 SECTION I:—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-EACH.DESCRIBED PREMISES' : . - The coverage's 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 --„•.,;, Coverage - Limit of Insurance ' Accounts Receivable , On Premises $50,000 Off Premises $15,000. , Arson Reward $5,000 -• -. Back-up of-Sewer or Drain: , •. . ,. - . $20,000 CollapseIncluded 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 $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration $10,000 Glass Expenses Included Policy Number:97-AA-3018-8 ,Page 2 of 5 Prepared:.February 18,2021 •©Copyright,State Farm'Mutual Automobile Insurance Company,2008. CMP-4000 ' U 00 State Farms Coverage Limit of Insurance _� , "-•• '`'' t ' L; 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 v.• - - o yN 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 premise's provided Coverage B-Business Personal Property) ' $5,000 '' • ' - ` Personal Property Off Premises $1.5,000 . Pollutant Clean Up and Removal ' . . . $10;000 Preservation of Property ` 30 days Property of Others(applies only'to those premise's'provided Coverage B-Business Personal Property) ^$2,500' ' •-•: • ' ' - Signs . $2,500 . Unauthorized Business Card Use $5;000 Valuable Papers and Records. On Premises $50,000 Off Premises '' $15;000 • Water Damage, Other Liquids,Powder or Molten Material Damage : • Included ', €••.• ' . . I 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 - Dependent Property-Loss of Income , .. . $5,000 Employee Dishonesty $10,000' _f ;;; Loss of Income and Extra Expense - 12 Months Actual Loss Sustained Utility Interruption-Loss of Income $10,000 s ' Policy Number:97-AA-G018-8 Page.3 of 5 Prepared:February 18,2021 . '©Copyright,StateFarm Mutual Automobile,lnsurance Company,2008 • CMP-4000 003840 ' ' • • Q State Farme SECTION II-LOCATION SCHEDULE, Location Locationof described premises number 001 545.A STSTE 3 . ASHLAND OR .97520-2051 SECTION II-LIABILITY Coverage Limit of Insurance Coverage L-Business Liability Per Occurrence, . • ,, , $2,00.0,000 . , Coverage M Medical Expenses- _ $10,000 Any One Person. Damage to Premises Rented to You $300,000 Aggregate Limits • Limit of Insurance Products/Completed Operations Liability-Annual Aggregate ; .• „Excluded •• 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 Covera a Form and anyattached e y • g� 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 thoseissued 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-46,83.1 'Additional Insured-Owners;Lessees or'Contractors;(Blanket) CMP-4584.1 ' Additional Insured:Owners,Lessees or Contractors(Scheduled) CMP-4703.1 :Utility Interruption-Loss of-Income'-- . " ' CMP-4704.1 • Dependent Property-Loss of Income i,;. • • CMP-4705:2 .; Loss of Income and Extra Expense = • • - .- ' - CMP-4706 Back-up of Sewer or,Drain 1 CMP-4709 Money and Securities `l+ ;, .. , ; :. ;i+t .+„'1 ., e :' i CMP-4710 Employee,Dishonesty - • CMP48191 Unauthorized BusinessCard Use• ' • CMP-4845 . Exclusion-•Products-Completed Operations Hazard FD-6007 Inland Marine Attaching Declarations: FE-3650 • Actual Cash Value`Endo-rsement 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 • Ashland OR 97520-1814 Policy Number 97-AA-G018-8 • • -Page 4 of 5 Prepared;February 18,2021 :©Copyright,State.Farm'Mutual Automobile-Insurance Company,2008 , , CMP-4000 U 090 StateFarm® ,.. FULL NAMED INSURED ,r. ` •Named Insured:KENCAIRN LANDSCAPE ARCHITECTURE LLC This policy is issued by the State Farm Fire and Casualty Company, g PARTICIPATING POLICY o 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 tobe signed by its President and Secretary at Bloomington, Illinois. cef rn President Secretary • Policy Number:97-AA-G018-8 Page 5 of 5 Prepared:February 18,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 003841 State Farm at CityLine u PO Box 853925 /�p� •Richardson,.TX 75085-3925 0°C)StateFar no • . State Farm.Fire and .Casualty,Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois ATTN: TAMI DEMILLE-CAMPOS 20EMAIN ST • ASHLAND OR 97520-181.4 o • • 0 DO Inland Marine Attaching Declarations Policy number: 97-AA-G018-8 Effective date: December 1, 2020 Policy period: 12 months Expiration date: October 29, 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 periodis shown as 12 months; this-policy will be renewed automatically subjectto 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'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: KENCAIRN LANDSCAPE ARCHITECTURE LLC • 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-G018-8 • Page 1.or 2 Prepared:February 18,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR 1009481 2001 153089 201 12-04-2018 FD-6007 003842 ,o o'StateFarme • Other limits and exclusions may apply refer to your policy,, • • • • • • Policy Number:97-AA-G018-8 Page 2 of 2 Prepared:February 18,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 • • CMP-4684.1 • Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. U.. y k� • • '{ADDITIONAL INSURED—OWNERS, LESSEES, OR.CONTRACTORS(Scheduled) This endorsement modifies insurance provided under the following: 0 BUSINESSOWNERS COVERAGE FORM . 6 'o SCHEDULE • Policy Number: 97-AA-G018-8 Named Insured: KENCAIRN LANDSCAPE ARCHITECTURE-LLC ' ATTN: TAMI DEMILLE-CAMPOS . '20 E MainSt ,' • . Ashland OR 97520-1814. . Name And Address Of Additional Insured Person Or Organization: . CITY OF ASHLAND . ATTN: TAMI DEMILLE-CAMPOS . • 20EMain 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.additio..nal..insured:'.shall..only.apply..with:.respect..to..a..claim.made or a.."suit"..brought fordamages..for.... which you are provided coverage. • ' 3. Primary Insurance. The insurance afforded the additional insured shall 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 03-20-2010 . ©, Copyright, State Farm Mutual Automobile Insurance Company,,2018 Includes copyrighted material of.Insurance Services Office,Inc.,with its permission. • • 003843 -