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HomeMy WebLinkAboutInsurance Certificate Amnd: Wild Rivers Surveying LLC (2) State Farm at CityLine PO Box 853925 Richardson, TX 75085-3925 0°0 State Farmo AT2 000515 1200.01 • State Farm Fire and Casualty Company THE CITY OF ASHLAND • A stock company with home officesr irvBloomingtori;;Illinois ;; 20 E MAIN ST ASHLAND OR.97520-1814 • S . Fo I11111 "Ii I 1r `� rIIIIIII. II II1 IIIIInllnl1111 11 11 n llnniriii cno Vr• S' • • Amended Declarations Policy number: 97-CN-X256-3 Effective date; December 7,2020 " Policy period: 12 months V . Expiration date: January 24, 202:1 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-periodPis shown os;12,months,.this;policy will be.renewed-,automatically/subject-Jo the; rules-and.-forms in!effect=for each succeeding policy-period.If_this:policy,is,terminated,_we will:give_ryou,and_the MortgageelL'ienholder written notice in compliance with the policy provisions oras required by law.' ' NAMED INSURED WILD RIVERS SURVEYING LLC 3339 GREEN ACRES DR CENTRAL POINT OR 97502-1413 = ENTITY - Limited.Liability Company REASONS FOR DECLARATIONS Your Policy is amendedeffectve'December 7,-2020 dueaosomerecentpollcy ch anges you requested. Enclosed ib'a 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 premiums)shown below is the 12 months premiums)for the characteristics of the policy as described in this`Declarations. ,_._ . , Total Premium: $380,00 , Discounts applied: • Business Experience Rating -•- . Renewal Discount V Business in Residence Premises Policy Number:97-CN-X256-3 Page 1.of 5 Prepared:December 21,2020 V ©Copyright,State Farm Mutual Automobile Insurance Company,2008. CMP Deo 3P'OR 1009462 2002 153090 202 12-05-2020 CMP-4000 . ' - 0°0 State Farm. 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 3339 GREEN ACRES DR No Coverage $26;700:. CENTRAL POINT OR 97502-1413 s *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 COVERAGEINDEX(ES) • Coy A-Inflation Coverage Index: N/A • Coy B-Consumer Price Index:. 256.8 SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE .$500 , SPECIAL DEDUCTIBLES:• - . „ ' Employee Dishonesty: $250 Equipment Breakdown: $500 • 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 thee Declarations, unless indicated by"See schedule". If a coverage does not have a corresponding limit shown below, but has"Ihcluded" indicated, refer to that policy provision foran explanation of that coverage. Coverage Limit of Insurance Accounts Receivable , On Premises ' $10,000 ' Off Premises $5,000 . ,, Arson Reward $5,000 Collapse.. Inciuded . 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 $2,500 Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration • $10,000 Glass Expenses Included Policy Number:97-CN-X256-3 Page 2 of'5 Prepared:December 21;2020 ©Copyright;State Farm Mutual Automobile Insurance Company,2008 • ' CMP-4000 U . Q90 State Farina Coverage Limit of Insurance 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 -- csJ - On Premises - • — • • - -- - $5,000 Off Premises $2,000 • • . 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 :.]", s :-1. • %.1 Pollutant Clean Up and Removal • $10,000 ' • Preservation of Property 30 days, • Property of Others(applies only to those premises provided Coverage B.:Biisiness 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 , $5,000 Loss of Income and Extra Expense 12 Months Actual.Loss Sustained SECTION II-LOCATION SCHEDULE Location Location of described premises number 001 3339 GREEN ACRES DR CENTRAL POINT OR 97502-1413 Policy Number:97-CN-X256-3 Page 3 of 5 Prepared:December 21,2020 , @ Copyright,'State Farm Mutual Automobile Insurance Company,2008 CMP-4000 • Q6 State Farm SECTION II-LIABILITY • Coverage Limit of Insurance''• • Coverage-L-Business Liability Per Occurrence - $2,000,000 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 Aggregate . , _ :.$5,000,000;- - ' ;- General Aggregate- -..$5,000,000, Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period Please refer to Section l I 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 ofthis 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-4683.1 Additional Insured-Owners,Lessees or.Contractors(Blanket), , CMP-4684.1 Additional Insured-Owners,Lessees or Contractors(Scheduled)- CMP-4705.2 Loss of Income and Extra"Expense CMP-4709 Money and Securities - . CMP-4710 Employee Dishonesty 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 SCHEDULE OF ADDITIONAL INTEREST(S) '' • v '�i ;PYr ,7', i. „ r? 'M1�" ,i Ali _.ir' ...� r.}y. ,Y.,.. Interest type: Owners,Lessees,or Contractors(Schedul .Endorsement number: .-CMP-4684.1 :. - Loan number: N/A The City of Ashland 20 E Main St Ashland OR 97520-1814 •., . . _ Policy Number:97-CN-X256-3 • .Page 4 of 5 Prepared:December 21„2020 ©Copyright,'State•Farm Mutual Automobile Insurance Company,2008 CMP-4000 u 090 State Far.°me 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 u)o Bloomington, Illinois.. •*. ,fit .. President Secretary Policy Number:97-CN-X256-3 Page 5 of 5 Prepared:December 21,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 : State Farm at CityLine PO Box 853925 Richardson, TX 75085-3925 CFO StateFarmo State Farm Fire and Casualty Company THE CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 20 E MAIN ST • ••• ASHLAND OR 97520-1814 o O 00 Inland Marino Attaching. Declarations Policy number:97-CN-X256-3 Effective date: December 7, 2020 Policy period: 12 months Expiration date: January 24, 2021 The policy period begins and ends at 12:01 am standard time at the premises location. ATTACHING INLAND MARINE Automatic renewal-lithe 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 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 Other limits and exclusions may apply-refer to your policy, Policy Number:97-CN-X256-3 . Page 1 of 1 Prepared:December 21,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Alt Dec 3P OR 1009481 2001 153089 201 12-04-2018 FD-6007 nnooen U • CMP-4684.1 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 1 ADDITIONAL INSURED—OWNERS, LESSEES, OR CONTRACTORS(Scheduled) • This endorsement modifies insurance provided under the following: I BUSINESSOWNERS COVERAGE FORM 0 SCHEDULE . Policy Number: 97-CN-X256-3 Named Insured: V WILD RIVERS SURVEYING LLC , 20EMain St Ashland OR 97520-1814 '• Name And Address Of Additional Insured Person Or'Organlzatlon: The City of Ashland 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 additional ihsured 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 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 03-20-2019 ©, Copyright,.State Farm Mutual Automobile Insurance Company,2018 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.