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HomeMy WebLinkAboutInsurance Certificate: Cascade Charter Co. LLC (2) State Farm at CityLine `J PO Box 853925 Richardson, TX 75085-3925 0 StateFarme AT2 000304 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices'in;Bloomington;:Illinois vil20EMAIN ST ASHLAND OR 97520-1814 . o _ - - ,-- co i 11 l i li ili i lil l I i I IIn 9 I i i it coo IIIA I II II I l III I linll I IIII I II I Il I n R:-.. : , .enewal Declarations : : ., " :. , .. , .. " : ,. . . . :, ' _1-'U ,1 , . , ,,, Policy number: 97-CP-R296-3 Effective date:April 1:, 2021 Policy period: 12 months Expiration date: April 1, 2022 ' i • ' '" 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:perio..d is sfiown.,as 12 months,',this;policymill be,rertewed,automatically'subject to the .premiums,_rules and forms..in effect for.each succeeding policy.period: If this policy is tejminated, we will give you arid the . Mortgagee/Lienholder writtennotice in compliance With the policy provisions or as required by law: NAMED INSURED CASCADE CHARTER COMPANY LLC. ' 2800 BIDDLE RD MEDFORD OR 97504-4115 ' ENTITY . ' , Limited Liability Company . , IMPORTANT MESSAGE(S), .. - ' Notice -Information concerning changes in your policy language is'included :Please call'Our agent if you haveany'questions:" r ' 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 premium(s)shown below is the 12 months premium(s)for the characteristics of the policy as described in this Declarations. v , Total Premium: $766.00 - S - - Discounts applied: • - , • ' Business Experience.Rating Renewal Discount ... Years in Business ' - S - • Policy Number:97-CP-R296-3 Page 1 of 5 Prepared:January 26,2021 ©Copyright,State.Farm Mutual Automobile Insurance Company,2008 . CMP Dec 3P OR 1009482 2002 153090 202 12-05.2020 CMP-4000 1 ' nn1 pi S , oo:StateFarina) 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 2800 BIDDLE RD $492,700 $36,900, , 25%. MEDFORD OR 97504-4115 " *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: 190.6 , Coy B-Consumer Price Index: 260.4 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' ' . , The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless unless indicated by"See schedule a If a coverage does not`have corresponding limit shown below, but has"Included" indicated, refer to that policy provision for an explanation of that coverage. s,:,. , •,'.v, • Coverage Limit,of Insurance • _ , Accounts Receivable On Premises $50,000 ,a.. Off Premises $15,000 Arson Reward $5,000 . . Back-up of'Sewer or Drain $15000 Collapse • Included thll',•,.'.1-,--, 10'i , Damage to Non-ownedBuildings 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-CP-R296-3 - --',,Page2 of 5 ' Prepared:January 26,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • " CMP-4000 , I-1 _ a StateFarrrno • Coverage Limit of Insurance `" -t+, ' ' '' t'i ' y 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 N 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) $5,000 Personal Property Off Premises $15,000 Pollutant Clean Up and Removal , .. - •. $10,000 , Preservation of Property `30 day 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 i $15,000 Water Damage, Other Liquids,Powder or Molten MaterialDamage 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 $10,000 Policy Number:97-CP-R296-3 • Page 3 of 5 Prepared:January 26,2021 ©'Copyright,State Farm Mutual Automobile Insurance Company;2008 CMP-4000 001282 a o StateFarm SECTION II-LOCATION SCHEDULE. ,s:. , Location Location of described premises , ,; number 001 2800 BIDDLE RD MEDFORD OR".97504=4115 SECTION II-LIABILITY Coverage Limit of Insurance Coverage L-Business Liability Per Occurrence• ; ' $2,000,000,.. • , r; 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 :. ,$4,000,09, . General Aggregate. L $4,000,000 Each paid claim for Liability Coverage reduces the.amount of insurance we provide duringthe applicable annual;period..Please refer to Section II Liability in the Coverage.Form and any attached endorsements: • , Your policy consists of.these Declarations,theBUSlNESSOWNERS COVERAGE FORM shown below andany 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-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 ,, , :, • , - .BMP-4705.2 Loss-of•Inconie-and Extra Expense, — - - - CMP-4706 Back-up of Sewer or Drain y, CMP-4709 Money.and Securities - •` '41, s 0.f x4 .,.t • i t -., uy�._.. • �E•y� a i • .CMP-4710 Employee Dishonesty ,, , CMP-4787 ' Waiver of Transfer of Rights of Recovery Against Others To Us' CMP-4819.1 Unauthorized Business Card.Use FD-6007 Inland Marine.Attaching Declarations FE-3650. . Actual Cash Value'Endorsement . .._.* 'FE-6999.3...: . • • u . Policyholder.Disclosure Notice'ofTerrorismInsurnce Coverage " e • '."'� ` ' : , *New Form Attached SCHEDULE OF ADDITIONAL INTEREST(Sr , , . . . Interest type:. Owners,Lessees,or Contractors(Schedul'. Endorsement number: CMP-4684.1 -Loan.number:. - . • N/A. -. . CITY OF ASHLAND 20EMain St Ashland OR 97520=1814 . Policy Number 97-CP-R296-3 Page 4 of 5 Prepared:January 26,2021 ©Copyright;State Farm Mutual Automobile Insurance;Company;;.2008 CMP-4000 u • 090 StateFarrn® 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. /Wielc.�.�C7` m President Secretary NOTICE TO POLICYHOLDER: 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 are also effective on the Renewal Date of this policy. 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 the actual 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-CP-R296-3 Page 5 of 5 Prepared:January 26,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 onions State Farm at CityLine PO Box 853925 Richardson, TX 75085-3925 00 State Farme State Farm Fire and Casualty Company „ L CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 20EMAIN ST . ASHLAND OR 97520-1814' o • O (Oo Inland "Marinè -Attachihg 'Declarations Policy number: 97-CP-R296-3 Effective date; April 1, 2021 Policy period: 12 months Expiration date:April 1, 2022 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 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-CP-R296-3 Page 1 of 1 Prepared:January 26,2021 ' • ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR 1009481 2001 153089 201 12-04-2018 FD-6007 ' 001284 ' • Li • CMP-4684.1 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I I ADDITIONAL INSURED—OWNERS, LESSEES,OR CONTRACTORS (Scheduled) . This endorsement modifies insurance provided under the following; • • § BUSINESSOWNERS COVERAGE FORM SCHEDULE • Policy Number: 97-CP-R296-3 Named Insured: • CASCADE CHARTER COMPANY LLC 20EMain 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 tothe 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 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. • 001285 • . .= r • • • • • • • p . 1. .i 1 ' • -) ' .1 l ♦r -":