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HomeMy WebLinkAboutInsurance Certificate Amnd: Studio Fuwafuwa, LLC State Farm at CityLine U PO Box 853925 Richardson, TX 75085-3925 Q StateFanne - AT2 000674 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois F:, . 20 E MAIN ST 4'7 ASHLAND OR 97520-1814 • . . O No Il i1 I11111111111111111'1191111111111111111111'111111111111111;11 . Amended Declarations . . .. : . , - --- , ,, ,, -. Policy number: 97-CP-D380-6 Effective date: December 4, 2020 Policy period: 12 months Expiration date: February 14, 2021 ' The policy period begins and ends at 12:01'am standard time at the premises location. OFFICE POLICY Automatic renewal -If the State Farm®policyperiod-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'incompliance With.the policy provisions or as required by law. - - - - ' NAMED INSURED STUDIO FUWAFUWA, LLC . PO BOX 1.03 . MEDFORD OR 97501-0007 ENTITY , Limited Liability Company REASONS FOR DECLARATIONS Your policy is amended effective-December 4, 2020 due to some recent policy changes you requested. Enclosed is a'copy of your' new.endorsements, if any. • POLICYPREMIUM , • , This is nota 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 asdescribed in this Declarations. Total Premium: $325.00 - Minimum Premium Discounts applied: - - Business Experience Rating - - ' - Renewal Discount • Years in Business . " - • - .Business in Residence Premises -. Policy Number:97-CP-D380-6 . Page 1 of 5 Prepared:December 4,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 , , • CMP Dec 3P OR 1009482 2002 153090 202 06-05-2020 CMP-4000 ' . ' , 003021 ' , &Q`StateFa He®® 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 27 SUMMIT AVE No Coverage $16,800 25% • .. MEDFORD OR 97501-2647 *As of the effective date of this policy, the Limit of Insurance as shown includes any increasein the limit due to Inflation Coverage. SECTION I—INFLATION COVERAGE INDEX(ES) Cov A-Inflation Coverage Index: N/A Coy B-Consumer Price Index:. 257.3 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. SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF'INSURANCE-EACH DESCRIBED PREMISES Thecoverages 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 "; 'i �'`...... • .. •. . Back-up of Sewer or Drain , . $15,000 Collapse Included Damage to Non-owned Buildings from Theft,Burglary or Robbery ' Coverage B Limit Debris Removal 25%of coveredloss- . 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-CP-D380-6 Page 2 of 5 Prepared:December 4,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 ' u . - 0 State.Farme Coverage Limit of Insurance ' : ''-•: ': .. - i..:, '.' 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 - . . .. . . . . . .. 0 �s IL N On Premises $10,000 `' "''=i ' we 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) $5,000' . -.• ' Personal Property Off Premises . . $15,000 . 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 Unauthorized Business Card Use $5,000 Valuable Papers and Records On Premises $50,000 '• , • - ' Off Premises • ' -• . , . - $15,000.: . 1 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 . ' • Dependent Property-Loss of Income • .• ' • $5;000 - • ' • Employee Dishonesty $10,000 Loss of Income and Extra Expense ' 12 Months Actual Loss Sustained . Utility Interruption-Loss of Income i $10,000 . , . , . Policy Number:97-CP-D380-6 1 - Page 3 of 5 Prepared:December 4,2020 ©Copyright,State Farm,Mutual Automobile Insurance Company,2008 CMP-4000 • 003022 0°0 StatFarm' SECTION II-LOCATION SCHEDULE • , Location Location of described premises number - 001 27 SUMMIT AVE MEDFORD OR 97501-2647 SECTION II-LIABILITY , Coverage Limit of Insurance Coverage L-Business Liability Per Occurrence .. • - $2,000,000 . 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.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 ' . CMP-4100Businessowners 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-4703.1 Utility Interruption-Loss of Income • CMP-4704.1 Dependent Property-Loss'of Income - . • CMP-4705.2 Loss of Income and Extra Expense • - •• ., - -- . . . CMP-4706 Back-up of Sewer or Drain ,;., rl,' , CMP-4709 Money and Securities CMP-4710 ,:• Employee Dishonesty. CMP-4819.1 Unauthorized Business Card Use * ‘CMP-4875 Loss Payable • , , 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: - Loss Payable-All Other - - - - Endorsement number: CMP-4875 , , ,. Loan number: -- • N/A.. . . . . . . . . .. . . .. . . . . , . • City of Ashland •20 E Main St Ashland OR 97520-1814 Policy Number:97-CP-D380-6 _ ' Page 4 of 5 Prepared:December 4,2020 ©Copyright,State Farm Mutual Automobile In,surance Company,2008 CMP-4000 • o State Farme 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 ithe 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 CI)o Bloomington, Illinois. /9 ` m President Secretary • Policy Number:97-CP-D380-6 Page.5 of 5 Prepared:December 4,2020 0 Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 • 003023 State Farm at CityLine U PO Box 853925 Richardson, TX 75085-3925 090 StateFarnr State Farm Fire and Casualty Company. CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois '' ..: 20 E MAIN ST *,fir. ASHLAND OR 97520-1814 S p Inland Marine . teaching Dedarat.i'ons • Policy number: 97-CP-D380-6 Effective date: December 4, 2020 Policy period: 12 months ' Expiration date: February 14, 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 MortgageelLienholder written notice in compliance with the policy provisions or as requiredby 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-5743.1 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-CP-D380-6 Page 1 of 1 Prepared:December 4,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM AR Dec 3P OR 1009481 2001 153089 201 12-04-2018 FD-6007 • 003024 • • • • • • - j' 'o ;'a ra • • • • ..1 1x. 111 'S. , 1 Li CMP-4875 Page 1 of 2' THIS ENDORSEMENT CHANGES THE POLICY, PLEASE'READ IT CAREFULL . - • LOSS PAYABLE This endorsement modifies ilisurance'provided under the following: , ; ,§ BUSINESSOWNERS COVERAGE.FORM SCHEDULE • Policy Number: 97-CP-D380-6 „•. . , ., . , , Named Insured: STUDIO FIJWAFUWA, LLC PO BOX 103 MEDFORD OR 97501-0007 Name And Address Of Loss Payee: City of Ashland . 20EMain St . ' . ,. , Ashland OR 97520-1814 Interest/Description Of Property: `" ' ' - A f additional insured, • S • • Loan Number: • Nothing in this endorsement increases the applicable Limit Of Insurance. We will not pay any Loss Payee more than their'financial interest in the Covered Property, and we will not pay more than the applicable Limit Of Insurance on the Covered Property. The following is added to the Loss,Payment'condition under SECTION I CONDITIONS.,, as shown by an "A", B" or "C". as the Interest shown in the Schedule above: • • A. Loss Payable For Covered Property in which both you and the Loss Payee shown in the Schedule have an.insurable:interest, we will: 1. Adjust losses with you; and 2.. Pay any claim for loss jointly to you.and the Loss Payee, as interests may,appear," • B. Lender's Loss Payable 1. The Loss Payee shown in,the Schedule.is a,creditor; including a mortgageholder or trustee,•.whose'interest in,that,Covered Property is established by such written contracts as: a. Warehouse receipts; b. A.contract for deed; c. Bills of lading; ' d. Financing statements; or ' e. Mortgages, deeds of trust, or security'agreements. CMP-4875 151391 06-05.2017 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material..of Insurance Services Office„Inc.,.with;its permission. 003025 CMP-4875 Page 2 of 2 2: For Covered Property in which both you and,aLoss`Payee have an insurable interest; a. We will pay for covered loss to each Loss Payee in their order of precedence, as interests may appear. b. The Loss Payee has the right to receive loss payment even if the Loss Payee has started foreclosure or similar action on the Covered.Property,. c., If we deny your claim because of your acts or because you have"failed to comply with the-terms of this policy; the Loss Payee will still have theright to receive loss payment if the Loss Payee; : ` , (1) Pays any premium due under this policy at our request if you have failed to do so; (2) Submits a signed, sworn proof of loss within 60 days after receiving notice from us of your failure to do so; and (3) Has notified us of any change in ownership, occupancy or substantial change in'risk known to the Loss Payee. All of the terms of this policy will then apply directly to the Loss Payee. d. If we pay the Loss Payee for any loss and deny payment to you because of your acts or because you have failed to comply with the terms of this policy: (1) The Loss Payee's rights will be transferred to us to the extent of the amount we pay; and (2) The Loss Payee's right to recover the full amount of the Loss Payee's claim will not be impaired. At our option, we may pay to the Loss Payee the whole principal on the debt plus any accrued interest. In this event, you will pay your remaining debt to us. 3. If we cancel this policy,we will give written notice to the Loss Payee at least; a. 10 days before the effective date of cancellation if we cancel for your nonpayment of premium;.or b. 30 days before the effective date of cancellation if we cancel for any other reason. 4. If we elect not to renew this policy, we will give writtennotice to the Loss Payee at least 10 days before the expiration date of this policy. C. Contract Of Sale ' 1. The Loss Payee shown in the Schedule is a person or:or`ganization you have entered a contract with'for the sale of Covered Property. 2. For Covered Property in which both you and the Loss•Payee have an insurable interest, we will; a. Adjust losses with you; and b. Pay any claim for loss jointly to you and the Loss Payee, as interests may appear, 3: The following is added to the,Other Insurance condition under SECTION I AND SECTION II ='COMMON POLICY CONDITIONS: For-Covered Property that is the subject of a contract of;sale, the.word"you" includes the Loss Payee,:- All other policy provisions apply. = CMP-4875 151391 05-05.2017' ©,'Copyright, State Farm Mutual Automobile'Insurance Company, 2008 Includes'copyrighted material of Insurance services Office, Inc.;with its permission.