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HomeMy WebLinkAboutInsurance Certificate: Cascade Airport Shuttle rom:PROPEL INSURANCE(Fax:12537592200 To: Fax:(541)552-2059 Page:2 of 3 0112912021 12:34 PM Client#: 172928 CASCAIRP ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY)1/29/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Thayona Primas Propel Insurance PHONE 800 499-0933 FAx (A/C,No,Ext): (a/c,No: 866 5�7-1326 Tacoma Commercial Insurance E-MAIL n RIESS: Thayona.Primas@propelinsurance.com 1201 Pacific Aver Suite 1000 INSURER(S)AFFORDING COVERAGE NAIC# Tacoma,WA 98402 INSURER A:Philadelphia Indemnity Ins Company 18058 J INSURED . INSURER B: Cascade Airport Shuttle ---- INSURER C: 3295 Hwy.66 Ashland,OR 97520-9500 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUB• POLICY EFF 1 POUCY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER LIMITS (MM/OD/YYYY)1(MMfOD/YYYY) COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ PR CLAIMS-MADE OCCUR ISE-Sr(Ei occu P nce) MED EXP(Any one erson) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ` GENERAL AGGREGATE r $ PRO-POLICY JECT LOC I PRODUCTS-COMP/OP AGG $ OTHER: ! $ A AUTOMOBILE LIABILITY I !PHPK2229991 02/08/2021 02/08/2022 CE0aMa �eDSINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOS ONLY I X TOS AUSCHEDULED BODILY INJURY(Per accident)1$ X AIT OS ONLY X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY (Per acciden . I _............. _—. $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION !PER _T5 j_2-W- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/NI E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I.N/A (Mandatory in NH) EL.DISEASE-EA EMPLOYEEI$ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Cityof Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main St ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZED REPRESENTATIVE I '10 CO 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S4466227/M4465973 TDPOO State Farm at CityLine r PO Box 853925 ® �r/� Richardson TX'75085-3925 C FO StateFaI�rm AT2 000978 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices'in;Bloomington;illliribis 1- .• 20 E MAIN ST .i' •'' ASHLAND OR."97520-1814 „ „ S llnlll111111IIIIli'IIliI1111111111111111111l1111111Iiulllliiilj.. • i2.4,ii: `k".. ;a(,:i •..(.':•'i .'';1.:'1(''- ; ;t, Renewal Declarations ,,,. .,._,, ,„,,,_,.,„:„, , ,,,„.}-4t : Policy number: 97-CP-D380-6 Effective date: February 14, 2021 • Policy period: 12 months • Expiration date: February 14, 2022 • • The policy period begins and ends at 12:01 am standard time at the premises location. . OFFICE POLICY • Automatic renewal -If the State Farris®;policy p•eriod;iS,:shown as_12 rnonths,:,this.policylwill-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'required by law. ' ' "' - " NAMED INSURED , . '. STUDIO FUWAFUWA, LLC • ' POBOX103 ._ - .-- ._ .. ' _. • . ._. . ,. , MEDFORD OR 97501-0007 ENTITY :. • Limited Liability Company ' IMPORTANT MESSAGE(S) Notice -Information concerning changes in your policy language is included. Please call your agent if you have any questions.''. '".,. 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 premiuin(s)shown below is the 12'months- pre►nium(s)for the characteristics of the policy as described 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 15,2020 , ©Copyright,.State Farm Mutual Automobile Insurance Company,2008 • ' •• ' . CMP Dec 3P OR 1009482 2002 153090 202'12-05.2020 CMP-4000 ' 004415 ` ° a StateFarme -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 $17,000 ,25% MEDFORD OR 97501-2647 *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: N/A 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 eacli described,premises shown these Declarations, . unless indicated by"See schedule". If a.coverage does not have a•bdrresponding limit shown below, but has"Included" indicated, refer to that policy provision for an explanation of that coverage.' Coverage Limit of Insurance Accounts Receivable On Premises $50,000 Off Premises $15,000 • Arson Reward $5,000 Back-up of Sewer.or Drain ,1 ; . $15,000 .- _ , , Collapse. Included -: ; .,.-, 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-CP-D380-6 Page 2 of 5, Prepared:December 15,2020 'b Copyright;State Farm Mutual Automobile Insurance Company,2006 = CMP-4000 . . u oo State Farm® Coverage Limit of Insurance;-•I ;;. . t;•'� ; 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 . ' 0 Money and Securities -- - - - • no • On Premises $10,000• ;,„a,i,., _•t,'J--'' 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. , - Water Damage, OtherLiquids,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 . . $10,000 . , • • . -Policy Number:97-CP-D380-6 Page 3 of 5 Prepared:December 15,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 .. 004416 ': o Statefarm SECTION II'-LOCATION SCHEDULE Location Location of described premises number • 001 27 SUMMIT AVE .,,; MEDFORD OR"9750'1 2647 .:,. ' SECTION II-LIABILITY' Coverage, Limit of Insurance , - Coverage'L-Business Liability Per Occurrence:',,Q-,; „,-,,•.i.,,, ,, • ',;;;$2,000 000:, •. , Coverage M-Medical Expenses , _ ., ,__ . $5,000 Any One Person_. _._ ._ ... Damage to Premises Rented to You $300,000_' • . Aggregate Limits t:: Limit.of Insurance Products/Completed OperationsAggregate• .:, ,,4 2..,. , . „ , •.' in $4,090,099.. . . • General Aggregate - $4,000,000 . . :!,:1,, ., _ . - 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. r s . 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-4100 . . Businessowners Coverage Form , . ,. _ • . . CMP-4237.11 Amendatory Endorsement(Oregon) • , CMP-4527 Marijuana Exclusion... CMP-4561.1 Policy Endorsement r•: '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 -- -- .: , -' . ,. - e CMP-4704.1 Dependent Property-Loss of Incom ' , . . : - . . , .. ,:- , ' - CMP-4705..-2 . -Loss-of Income and Extra Expense• . -,, -h• ._. CMP-4706 Back-up of Sewer.or Drain . ,r ,.. ,ry r ., ,, CMP-4709' Money and Securities C: ... _,,. ,, rt.J•,' ,...P ,,.,6k:,` 3_ ,,..1” o rot. •1 ? .,, . - CMP-4710• - Employee Dishonesty.. ' --1 ,, , CMP=4819,1 "Unauthorised Business Card Use * CMP-4875 .Loss Payable • FD-6007 Inland'Marine Attaching Declarations FE-3650 Actual Cash'Val"ue Endorsement *. FE-6999:3 ' .. Policyholder Disclosure-Noticeof Terrorism'In`surance`Coverage '• .. ..*New Form Attached . .. . „ . . . SCHEDULE.OF ADDITIONAL INTEREST(S); •'' . Interest type:. Loss Payable At 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 15,2020 '0'Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 • 0 State Farm 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 besigned by its President and Secretary at Bloomington, Illinois. , /frit e-Ldia sqg •Ac•-u•-) 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 contractorsand 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-D380-6 Page 5 of 5 Prepared:December 15,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 . ' CMP-4000 004417' " ' • State Farm at CityLine U PO Box 853925 - Richardson, TX 75085-3925 O D StateFarm State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington,. Illinois. 20 E MAIN ST ASHLAND OR 97520-1814 O O tcA cOo • Inland Marine Attaching 'Declarations Policy number: 97-CP-D380-6 Effective.date: February 14, 2021 Policy period: 12,months Expiration date: February.14, 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-87431---.- . -.-.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 15,2020 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR 1009481 2001 153089 201 12-04-2018 FD-6007 004418 u CMP-4875 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. " ' LOSS PAYABLE This endorsement modifies insurance provided:under the.following : . •' h BUSINESSOWNERS COVERAGE FORM 0 c'n'o SCHEDULE Policy Number: 97-CP-D380-6 ,. : Named Insured: . , STUDIO EUWAFUWA,.LLC PO BOX 103 MEDFORD OR 97501-0007 Name And Address Of Loss Payee: City of Ashland 20 E Main.St Ashland OR 97520-1814 Interest/Description Of Property: A/additional insured ' 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 shownby 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.:claimfprloss_jointlyto-.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 06-06-2017 ©,`Copyright,,State,Farm Mutual Automobile'Insurance Company;'2008 ' Includes copyrightedmaterial:'of.Insurance Services.Office,,Inc.,with its permission. 004419 ' CMP-4575 Page 2 of 2 2. For Covered Property in which both you and a Loss 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 the right 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 ofloss within 60 days after receiving notice from us of your failure to do so; and (3) Has notified usof 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 thedebt 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•shownin the Schedule":is a'person''or.organization 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.O6-z017 ©;Copyright; State'Farm.Mutual Automobile'•Insurance Company,-2008 Includes copyrighted'material of Insurance Services Office, Inc:,with its permission.